Providing notifications to authorized users

ABSTRACT

A method and system for initiating message listening and routing message content to authorized user devices is disclosed. For a second user device to receive notifications regarding records of a first user, the second user device provides information identifying the first user to a notification service. The notification service verifies the identifying information. The notification service initiates one or more listeners to listen for messages flowing over a messaging bus that are relating to the first user. Once a message is identified, at least a portion of the message is used to generate a notification that may be sent to the second user device.

CROSS-REFERENCES TO RELATED APPLICATIONS

The present application is a continuation of U.S. application Ser. No.15/980,575, filed May 15, 2018, and entitled “PROVIDING NOTIFICATIONS TOAUTHORIZED USERS,” which is a continuation-in-part of U.S. applicationSer. No. 15/896,788, filed Feb. 14, 2018, issued as U.S. Pat. No.10,505,935, and entitled “PROVIDING NOTIFICATIONS TO AUTHORIZED USERS,”which is a continuation of U.S. application Ser. No. 14/954,249, filedNov. 30, 2015, issued as U.S. Pat. No. 9,906,532, and entitled“PROVIDING NOTIFICATIONS TO AUTHORIZED USERS,” which is a continuationof U.S. application Ser. No. 14/630,393, filed Feb. 24, 2015, issued asU.S. Pat. No. 9,203,814, and entitled “PROVIDING NOTIFICATIONS TOAUTHORIZED USERS,” which claims the benefit of U.S. Application No.61/943,871, filed on Feb. 24, 2014, and entitled “MEDICAL MESSAGINGSYSTEM.” U.S. application Ser. No. 15/980,575 is also acontinuation-in-part of U.S. application Ser. No. 15/476,243, filed Mar.31, 2017, issued as U.S. Pat. No. 9,973,455, entitled “MESSAGECUSTOMIZATION AND ROUTING,” which claims the benefit of U.S. ApplicationNo. 62/316,213, filed Mar. 31, 2016, entitled “HEALTH INFORMATIONEXCHANGE SERVICE BUS”. The entire disclosures of the above applicationsare hereby incorporated by reference, for all purposes, as if fully setforth herein.

This specification relates in general to notification systems and, butnot by way of limitation, to initiating message listening and routingmessage content to authorized user devices.

A record management system may manage records for many different users.In some cases, some of the records are adjustable by entities internalto the record management system and to other entities external to therecord management system. In any event, a user to whom the recordbelongs may be interested in receiving a notification when a record isadjusted (e.g., changed, saved, altered, improved, etc.). Providing suchnotifications, while maintaining protection of sensitive informationpertaining to the adjusted record, may prove difficult usingconventional systems. This difficulty may be magnified when the userdesires that other users receive similar notifications.

SUMMARY

In one example, systems and methods are provided for initiating messagelistening and routing message content to authorized user devices. Insome examples, a notification request is received from a first userdevice of a first user. The notification request is indicative of arequest that one or more second user devices be provided withnotifications specifying one or more decisions made or actions performedin relation to responding to current conditions. The current conditionspertain to the first user. In some examples, an authorization request isreceived from a second user device of the one or more second userdevices. The authorization request includes identifying information ofthe first device or the first user. In some examples, in response toreceiving the authorization request, it is determined that the seconduser device is authorized to receive the notifications specifying theone or more decisions made or actions performed in relation toresponding to the current conditions. The determining is based at leastin part on verifying at least a portion of the identifying informationincluded in the authorization request. In some examples, one or morelisteners are initiated. The one or more listeners are configured tolisten for messages on a messaging bus that identify the first userdevice or the first user. The messages are generated in response to onemore events. A portion of the messages are generated by one or morecomponents in network communication with the messaging bus. In someexamples, a message is received in response to one of the one or morelisteners listening for messages on the messaging bus that identify thefirst user device or the first user. In some examples, a notification isgenerated in accordance with one or more notification rules. Thenotification describes at least one aspect of the message. In someexamples, the notification is transmitted to the second user device ofthe one or more second user devices.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments in accordance with the present disclosure will bedescribed with reference to the drawings, in which:

FIG. 1 is an example block diagram illustrating an environment in whichtechniques relating to initiating message listening and routing messagecontent to authorized user devices as described herein may beimplemented, according to at least one example;

FIG. 2 is an example block diagram illustrating an environment in whichtechniques relating to initiating message listening and routing messagecontent to authorized user devices as described herein may beimplemented, according to at least one example;

FIG. 3 is an example schematic model illustrating an a networkcommunication model in which techniques relating to initiating messagelistening and routing message content to authorized user devices asdescribed herein may be implemented, according to at least one example;

FIG. 4 is an example schematic model illustrating an aspect of thenetwork communication model of FIG. 3 in more detail;

FIG. 5 is an example schematic model illustrating an aspect of thenetwork communication model of FIG. 3 in more detail;

FIG. 6 is an example schematic model illustrating an aspect of thenetwork communication model of FIG. 3 in more detail;

FIG. 7 is an example schematic model illustrating an aspect of thenetwork communication model of FIG. 3 in more detail;

FIG. 8 is an example schematic architecture illustrating a network inwhich techniques relating to initiating message listening and routingmessage content to authorized user devices as described herein may beimplemented, according to at least one example;

FIG. 9 is an example block diagram illustrating an environment in whichtechniques relating to initiating message listening and routing messagecontent to authorized user devices as described herein may beimplemented, according to at least one example;

FIG. 10 is an example schematic architecture illustrating a network inwhich techniques relating to initiating message listening and routingmessage content to authorized user devices as described herein may beimplemented, according to at least one example;

FIG. 11 is a flow diagram depicting example acts for implementingtechniques relating to initiating message listening and routing messagecontent to authorized user devices as described herein may beimplemented, according to at least one example;

FIG. 12 is a flow diagram depicting example acts for implementingtechniques relating to initiating message listening and routing messagecontent to authorized user devices as described herein may beimplemented, according to at least one example; and

FIG. 13 is a flow diagram depicting example acts for implementingtechniques relating to initiating message listening and routing messagecontent to authorized user devices as described herein may beimplemented, according to at least one example.

DETAILED DESCRIPTION

The ensuing description provides preferred exemplary embodiment(s) only,and is not intended to limit the scope, applicability or configurationof the disclosure. Rather, the ensuing description of the preferredexemplary embodiment(s) will provide those skilled in the art with anenabling description for implementing a preferred exemplary embodiment.It is understood that various changes may be made in the function andarrangement of elements without departing from the spirit and scope asset forth in the appended claims.

In some examples, the present disclosure provides systems and methods tosubscribe a member of the public (e.g., a second user) to receiveinformation regarding the treatment of a first user (e.g., a patient).In this example, the first user requests that a notification serviceprovide such messages. To do so, the first user signs up for thenotification service at a physical location within a facility (e.g.,within a medical care facility), online, or the like and requests thatthe message service provide notifications to the second user (i.e.,indicates that the first user approves of the notification servicesending notifications and/or messages to authenticated members of thepublic). In some examples, this includes providing authorization thattext messages be sent to user devices of the first user and the seconduser, once the second user is authorized. The notification service usesa handshake protocol to authenticate that the second user and the seconduser device are authorized to receive the notifications, which mayinclude patient care information. In this example, the first user (e.g.,patient) is identified by a unique patient identifier (ID), her date ofbirth, a social security number (e.g., a nine-character governmentidentifier), and other identifying information. In some examples, thesecond user is a close family member with whom the first user has shareda portion of his or her identifying information or whom the first userhas previously authorized to receive text message updates. In thisexample, the first user identifies an authorized user by sharing aunique code with the particular person. The code is received from thenotification service and enables the recipient to become authorized byinteracting with the notification service. In some examples, the uniquecode includes a portion of the identifying information and/or isgenerated based in part on the identifying information. In otherexamples, the second user the first user, a medical professional, afamily member, or other authorized user. The notification servicemonitors the flow of messages within a record system (e.g., a medicalrecord system) and keeps the authorized users (e.g., the second userafter successful authorization) informed of the first user's processflow (e.g., as the patient progresses through care at a medical carefacility) using the text messages. This can include, for example, namesof physicians, assigned nurses, assigned rooms, services ordered, whentests are received, medications, commencement of procedures, conclusionof procedures, order for prescriptions, orders for tests, etc. While thenotification services does provide status updates in the form ofnotifications, it includes safeguards to remove protected healthinformation (PHI) from its text message updates.

In some examples, the notification service monitors messages that flowover a common messaging bus to determine messages which are related tothe first user. This may include, for example, identifying messages thatinclude the first user's name, unique patient ID, and the like. Themessaging bus includes a plurality of virtual pipes (or domains)according to which components and other systems provide messages (e.g.,medical messages). For example, when a professional user (e.g., amedical professional such as a doctor, nurse, surgeon, etc., which maybe the second user) adds a note to the medical record of the first userat a first computer, the first computer may send the updated note (e.g.,a message) to a record service via the messaging bus. The notificationservice then identifies the updated note as it flows over the messagingbus. In order to identify such messages, the notification serviceinitiates one or more bus listeners which have access to the messagingbus. The one or more bus listeners include software and/or hardwareconfigured to identify certain messages and publish those messages toother systems, entities, and the like. An example bus listener proceedsthrough one or more authentication steps in order to retrieve messagesfrom off the bus. As part of authentication or otherwise, in thisexample, the messaging bus includes one or more divisions via hardware,software, or the like to maintain de-identified and identified PHIseparate. Such divisions enable the notification service to comply withgovernment regulations relating to the handling of PHI, such as theHealth Insurance Portability and Accountability Act (HIPAA). Thenotification service also includes a look-up table that includes patientidentifying information. When a listener identifies a record change, thenotification service utilizes the look-up table to match the recordchange with the first user in order to pull the message corresponding tothe first user from the messaging bus. This message may include recordinformation (which may be generic). The message can then be processed(e.g., determine what information should be taken off the bus, translateto a useable format, determine how to transfer it, determine to whom tosend it, etc.) and transferred to the end point (e.g., second userdevice, cell phone, email, twitter feed) associated with the second userand other authorized users.

Once it is determined that a message or a portion of a message should besent to the second user, a notification may be generated. Thenotification may be based on the message and in a format capable ofbeing received by a user device of the second user. The notification (orthe message or the portion of the message) is provided to a messagingvendor. The messaging vendor may adjust the message prior to sending tothe user device of the second user. In some examples, the messagingvendor obtains the notification from the notification service via avirtual private network.

Referring first to FIG. 1 , a block diagram of an embodiment of amedical provider network 100 is illustrated. The medical providernetwork 100 includes a plurality of elements connected with directionalarrows. The directional arrows not only indicate that the elements areconnected, but also indicate the direction that data may flow withrespect to the various elements. For example, data may flow between thefollowing elements of the medical provider network 100: a transformativeintegration engine 102 and a transaction management engine 104.

Generally, the transformative integration engine 102 is configured tocollect and aggregate medical-related data from components of themedical provider network 100 and components outside of the medicalprovider network 100. Once the transformative integration engine 102collects and aggregates the medical-related data, it may perform one ormore operations with respect to the data and store it in a data store.This stored medical-related data can then be accessed by componentswithin and without the medical provider network 100.

The medical-related data is transmitted throughout the medical providernetwork 100 in accordance with any suitable transmission protocol.Generally, the transaction management engine 104 is configured to managethe flow of such transmissions within the medical provider network 100.Thus, the transaction management engine 104 receives indications oftransmissions of medical-related content and tracks the originationlocations of the transmissions, the destination locations of thetransmissions, and any locations there between.

The medical provider network 100 includes one or more components 106 andone or more user devices 108. The one or more components 106 areconfigured to share medical-related data with the transformativeintegration engine 102, the transaction management engine 104, and eachother via one or more communication networks. The one or more userdevices 108 are configured to access medical-related data collected bythe transformative integration engine 102 and provide their ownmedical-related data. Users of the one or more user devices 108 may usesuch medical-related data to help the users make medical decisions.While the one or more components 106 and the one or more user devices108 are illustrated as communicating via the transformative integrationengine 102 and/or the transaction management engine 104, thisspecification is not so limited. For example, each of the one or morecomponents 106 may communicate with each of the one or more user devices108 directly via other or the same communication networks. Each of theone or more components 106 of the medical provider network 100 is anexample of a device, medical equipment, a lab system, a businessterminal, a clinical terminal, or the like that can receive and/orprovide medical-related data as further detailed herein. Each of the oneor more user devices 108 is an example of a user device that can receiveand/or provide medical-related data as further detailed herein. In someexamples, at least some of the one or more user devices 108 may functionsimilar to at least some of the one or more components 106 andvice-versa. In other words, each of the one or more user devices 108 andeach of the one or more components 106 may both provide data and accessdata within the medical provider network 100.

In some examples, the one or more components 106 are each associatedwith one or more medical provider organizations within the same ordifferent medical provider networks. For example, certain ones of theone or more components 106 may be associated with a first medicalprovider organization, while other ones of the one or more components106 may be associated with a second medical provider organization.Additionally, each of the one or more components 106 may be associatedwith a medical care facility 110. The medical care facility 110illustrates an example of one medical care facility. The medicalprovider network 100, however, may include many different types ofmedical care facilities (e.g., urgent care facilities, outpatientfacilities, hospitals, clinics, and medical record service facilities)including many different types of components. In some examples, the oneor more components 106 are not associated with one of the medical carefacilities 110, but instead are included as part of an informationsystems company that manages medical-related data such as electronicmedical records.

The one or more components 106, irrespective of which medical providerorganization each belongs to, may be capable of receiving, generating,processing and/or transmitting medical-related data. Examples of the oneor more components 106 include, for example, a user device (e.g.,computer, mobile device, smart phone, laptop, electronic badge, set-topbox, thin client device, tablet, pager, and other similar user devices),clinical lab equipment (e.g., fluid processing device, chemistryanalysis device, coagulation analysis device, DNA analysis device,genetic analysis device, urinalysis device, hematology analysis device,immunology analysis device, and other similar lab equipment), medicalequipment (e.g., surgery tools, imaging machines, and other similarmedical devices), business and/or administrative device that can receiveinput from (for example) a nurse, administrator, receptionist, secretaryor assistant (e.g. server, computer, mobile device, smart phone, laptop,electronic badge, set-top box, thin client device and other similarbusiness and/or administrative devices), and other similar devicescapable of generating medical-related data. The one or more components106 also includes entities that collect, aggregate, and storemedical-related data. Some of these entities may be third-parties thatmake medical-related data available to the transformative integrationengine 102.

The one or more components 106 provide medical-related data using one ormore formats, some of which can be proprietary. For example, a magneticresonance imaging (MRI) machine (e.g., one of the one or more components106) manufactured by company A, located within a first medical carefacility (e.g., the medical care facility 110), and belonging to a firstmedical provider organization, may save and transfer data in a firstformat. An MRI machine (e.g., one of the one or more components 106)manufactured by company B, located within the first medical carefacility (e.g., the medical care facility 110), and belonging to thefirst medical care provider, may save and transfer data in a secondformat. In some examples, medical-related data from certain componentsis transformed, translated, or otherwise adjusted to be recognizable bythe transformative integration engine 102. Thus, continuing with theexample from above, when the Mill machines manufactured by companies Aand B are located within the first medical care facility belonging tothe first medical care provider, they may nevertheless save and transferdata in different formats. In some examples, the one or more components106 communicate using the Health Level-7 (HL7) standard for hospitalinformation systems or any other suitable format.

The transmission of medical-related data from the one or more components106 to the transformative integration engine 102 may be triggered by avariety of different events. For example, the medical-related data maybe transmitted periodically, upon detection of an event (e.g.,completion of an analysis or end of a procedure), upon detection of anevent defined by a rule (e.g., a user-defined rule), upon receiving userinput triggering the transmission, or upon receiving a data request fromthe transformative integration engine 102. Each transmission caninclude, e.g., a single record pertaining to a single patient,procedure, or analysis or multiple records pertaining to multiplepatients, procedures, or analyses.

In some examples, at least some of the one or more user devices 108 areassociated with the medical care facility 110. At least some of the oneor more user devices 108 may not be associated with the medical carefacility 110 or any other medical care facility. Similar to the one ormore components 106, the one or more user devices 108 may be capable ofreceiving, generating, processing and/or transmitting medical-relateddata. Examples of the one or more user devices 108 include, for example,a computer, a mobile device, a smart phone, a laptop, an electronicbadge, a set-top box, a thin client device, a tablet, a pager, and othersimilar user devices). The one or more user devices 108 may differ fromthe one or more components 106 because the one or more user devices 108may be configured to run one or more applications developed forinteracting with the medical-related data collected by thetransformative integration engine 102. For example, those user devicesof the one or more user devices 108 that are not associated with themedical care facility 110 may be configured to run one or morethird-party applications that may rely in part on the medical-relateddata gathered by the transformative integration engine 102.

Each of the one or more components 106 and the one or more user devices108 may be utilized by one or more users (not shown). Each of the one ormore users may be associated with one or more medical providerorganizations. For example, one of the one or more users can beassociated with a medical provider organization as a result of beingemployed by the organization, physically located at a location of theorganization, being an agent of the organization or receiving a medicalservice from the organization.

The connections between the one or more components 106 and the one ormore user devices 108 and the transformative integration engine 102 andthe transaction management engine 104 are illustrated by a plurality ofbi-directional arrows indicating that medical-related data may flowtherebetween. The medical-related data flows in either direction withinthe medical provider network 100 (e.g., from the transformativeintegration engine 102 and the transaction management engine 104 towardsthe one or more components 106 and/or the one or more user devices 108or to the transformative integration engine 102 and the transactionmanagement engine 104 from the one or more components 106 and/or the oneor more user devices 108). The connections between the one or morecomponents 106 and the one or more user devices 108 and thetransformative integration engine 102 and the transaction managementengine 104 can include any suitable network connection. A connection canbe configured to support communication over a wireless medium, e.g.,using Wi-Fi (IEEE 802.11 family standards), Zigbee, Bluetooth® (a familyof standards promulgated by Bluetooth SIG, Inc.), Bluetooth Low Energyor other protocols for wireless data communication. In some instances, aconnection can include a wired connection.

In some examples, the one or more components 106 and the one or moreuser devices 108 may communicate with the transformative integrationengine 102 and the transaction management engine 104 via differentinformation formats, different proprietary protocols, differentencryption techniques, different languages, different machine languages,and the like. As will be discussed with reference to FIG. 2 , thetransformative integration engine 102 is configured to receive thesemany different communications from the one or more components 106, andin some examples from the one or more user devices 108, in their nativeformats and transform them into any of one or more formats. The receivedand/or transformed communications can be transmitted to one or moreother devices (e.g., the transaction management engine 104, an entitydevice and/or a user device) and/or locally or remotely stored. In someexamples, the transformative integration engine 102 receivesmedical-related data in the HL7 format or conforming to any othersuitable format and/or is configured to transform received data toconform with the HL7 format.

In some examples, the medical provider network 100 may not include thetransformative integration engine 102, or may include part of thefunctionality described herein. For example, when the communicationsbetween the one or more user devices 108 and between the one or morecomponents 106 are in the same format, the transformative integrationengine 102 may not be required to transform the communications intoother formats.

As used herein, medical-related data can include, for example, healthinformation that is created or received by a health care provider, aprocessed or unprocessed version of medical data detected by medicalequipment, and/or user-identified data. Medical-related data can includeinformation that identifies a patient, such as personal informationand/or demographic information. For example, the information canidentify a patient's name, age, sex, race, physical address, phonenumber, email address and/or social security number. Medical-relateddata may include information collected by a health plan, a public healthauthority, an employer, a life insurer, a school or university, or ahealth care clearinghouse that relates to the past, present, or futurephysical or mental health or condition of any individual.

Medical-related data can include financial and/or insurance informationcorresponding to the patient. For example, the information can identifyan insurance company, insurance plan, member identification number,group number, insurance contact information (e.g., address and/or phonenumber), deductible information, out-of-pocket information, copayinformation, an employer, an occupation and/or salary information.

Medical-related data can include medical-history information, such aspast diagnoses, past or present symptoms or past procedures and/orcorresponding dates (e.g., of diagnoses, symptom initiations and/orprocedures). Medical-related data can identify past or presentmedications being taken by or having been prescribed to the patient andcorresponding dates. In some examples, the medical-related data canidentify orders pharmacology orders, whether associated with a patient,doctor, or otherwise.

Medical-related data can include an identification of one or moremedical services having been, being or having been requested by apatient. A medical service can include, for example, an evaluationperformed by a medical care professional, a medical test, a surgeryand/or other procedure. Medical-related data can identify a medical testor analysis that was performed or prescribed and/or a result of the testor analysis. For example, information can indicate that a test (e.g.,lab test, Mill, x-ray, CT scan, echocardiography, EKG, EEG, EMG, orultrasound) was performed on a particular date and/or by a particularentity and can further include a processed and/or unprocessed result ofthe test (e.g., a count or level; an indication as to whether a testresult is normal; and/or an indication as to whether a particularfeature (e.g., a fracture, tumor, lesion, slowed nerve conduction) wasobserved and/or a magnitude of the feature). Medical-related data caninclude any information pertaining to genes of generic populations,patients, sets of patients, living organisms, and of any other suitablegroup. Information pertaining to genes includes, for example, genomicinformation (e.g., DNA sequencing), hereditary information, classicalgenetic information, molecular genetic information, any other suitableinformation pertaining to genes.

Medical-related data can identify one or more care providers orinstitutions. The care provider and/or institution can be one associatedwith recent or past care and/or with the patient. For example, data canbe transmitted for a patient admitted in Hospital A and being treated bySpecialist B, though the data can also identify that the patient'sprimary care physician is Doctor C.

Medical-related data may, or may not, selectively pertain to aparticular patient. For example, non-patient-specific data may include aprice of a prescription, a recommended or approved dosing schedule for amedication, a work schedule for a physician, an acceptance criteria fora clinical study, non-patient-specific data can include informationpertaining to the operation of a medical care facility, financialinformation, administrative information, and generic clinicalinformation.

Medical-related data can, depending on the implementation, includeindividually identifiable health information and/or de-identifiedinformation. Individually identifiable health information includes, forexample, health information, including demographic information collectedfrom an individual that is created or received by a health careprovider, health plan, employer, or health care clearinghouse; and thatrelates to the past, present, or future physical or mental health orcondition of an individual, the provision of health care to anindividual, or the past, present, or future payment for the provision ofhealth care to an individual; and that identifies the individual; or,with respect to which there is a reasonable basis to believe, can beused to identify the individual. De-identified information includesinformation that cannot be used on its own or with other information toidentify a person to whom the information belongs.

As used herein, medical-related data can include protected healthinformation, which can include individually identifiable healthinformation that is transmitted by electronic media, maintained inelectronic media, or transmitted or maintained in any other form ormedium. Examples of protected health information, include, for exampleany information about health status, provision of health care, orpayment that can be linked to a particular patient and may include anyof the following information capable of identifying the patient: names,geographic identifiers, dates directly relating to the patient, phonenumbers, fax numbers, email addresses, social security numbers, medicalrecord numbers, health insurance beneficiary numbers, account numbers,certificate/license numbers, vehicle identifiers and serial numbers,device identifiers and serial numbers, web Uniform Resource Locators,Internet Protocol addresses, biometric identifiers (e.g., finger,retinal, and voice prints), full face photographic images and anycomparable images, and any other unique identifying number,characteristic, or code.

The one or more components 106 of the medical care facility 110 caninclude and/or has access to a local or remote memory for storinggenerated medical-related data. In some examples, the medical-relateddata is stored by one or more servers local to the medical care facility110. Such storage may enable the medical care facility 110 to retainlocally medical-related data pertaining to its own patients prior to (orin conjunction with) the medical-related data being shared with thetransformative integration engine 102 and/or the transaction managementengine 104. In some examples, the one or more servers of the medicalcare facility 110 share medical-related data directly with a recordservice (not shown), and the record service makes the medical-relateddata available to the transformative integration engine 102 and/or thetransaction management engine 104. Once an electronic medical record isupdated at the medical care facility 110, an indication of the updatemay be provide to the record service. The record service may then updatea corresponding record associated with the electronic medical record.

The record service can be granted access to the medical-related datagenerated and/or transmitted by the one or more components 106. In someexamples, the record service includes a server or a plurality of serversarranged in a cluster or the like. These server(s) of the record servicecan process and/or store medical-related data generated by the one ormore components 106. For example, one or more records can be generatedfor each patient (e.g., each record corresponding to a different entityor being shared across entities). Upon receiving a communication withmedical-related data from an component (or medical care facility), therecord service can identify a corresponding record and update the recordto include the medical-related data (or processed version thereof). Insome examples, the record service provides medical-related data to thetransformative integration engine 102.

The medical care facility 110 is a facility at which care is provided topatients. Irrespective of the type of medical care facility, the medicalcare facility 110 may treat patients, update medical-related data,maintain medical-related data, and communicate medical-related data tothe transformative integration engine 102. At least some of themedical-related data may be stored local to the medical care facility110. Further, the one or more components 106 within the medical carefacility can generate medical-related data including administrativeinformation, clinical information, and financial information as parttheir operations within the urgent care facility. Examples of medicalcare facilities include, for example, urgent care facilities, outpatientfacilities, hospitals, clinics, and other suitable facilities at whichcare is provided to patients.

The medical care facility 110 can be an urgent care facility, aninsta-care facility, an emergency room, or the like. For example, adoctor may update a particular electronic medical record of a patientusing one of the one or more components 106 or one of the one or moreuser devices 108 after receiving the patient in the course of anemergency. In some examples, the urgent care facility may be distinctfrom an office of the patient's primary care provider. However, inaccordance with techniques described herein, the updates to theelectronic medical record may be made available to the patient's primarycare provider, including any medical-care professionals. The update canalso be saved locally in association with the patient's electronicmedical record, a copy (or the original) can be provided to thetransformative integration engine 102, and an indication of the updatecan be provided to the transaction management engine 104. In someexamples, the indication of the update is generated by the transactionmanagement engine 104 as the update is provided to the transformativeintegration engine 102.

The medical care facility 110 can be an outpatient facility (e.g., along-term care facility, a recovery facility, a hospice facility, arehabilitation center, a retirement home, or the like). Such a facilitymay In some examples, the outpatient facility provide medical care topatients who are not admitted to a hospital. Additionally, componentswithin the outpatient facility generate medical-related data (e.g.,administrative information, clinical information, and financialinformation) as part their operations within the outpatient facility.For example, an outpatient facility may provide treatment to a patientusing a dialysis machine. Information pertaining to the treatment of thepatient using the dialysis machine can be stored locally, and a copy canthen be provided to the transformative integration engine 102 such thatit can coordinate storage and later retrieval of the information for useby one or more others of the one or more components 106 of the one ormore user devices 108. In addition, an indication of the update to themedical-related data is provided to the transaction management engine104 (e.g., directly or via transformative integration engine 102). Therecord service can also maintain updated medical-related data includingelectronic health record information from the outpatient facility.

The medical care facility 110 can be a hospital (e.g., a type of medicalcare facility that provides medical, surgical, and other types ofmedical and nursing care). In this example, the hospital includes one ormore different wards dedicated to the care and treatment of patientswith particular diseases, disorders, and the like. Within the wards, thehospital includes a variety of different components capable ofgenerating medical-related data. The hospital can store a portion of thegenerated medical-related data for its own patients locally. In someexamples, users (e.g., patients, doctors, etc.) may utilize the one ormore components 106 and/or the one or more user devices 108 to generatesuch medical-related data. For example, the hospital may include, as oneof its components, an MRI machine. A technician (e.g., a user) maycollect one or more MRI images of a patient using the MRI machine at thehospital. These MRI images, a form of medical-related data, can bestored locally, and a copy of the file can be provided to thetransformative integration engine 102, which can coordinate storage andlater retrieval of the information for use by one or more others of theone or more components 106 of the one or more user devices 108.

In addition, an indication of the medical-related data can be directlyor indirectly provided to the transaction management engine 104.Components of the hospital can also or alternatively communicate themedical-related data to the transformative integration engine 102 or therecord service. In this manner, the transformative integration engine102 has access to updated medical-related data for the patients of thehospital.

The medical care facility 110 can be a clinic (e.g., an organization ofmedical care professionals that provide routine medical care). In thisexample, the treatment offered by the clinic is devoted primarily tooutpatients. The clinic offers medical services options to populationsin local communities and, in some examples, provides medical services topatients prior to the hospital providing medical services.

The medical provider network 100 includes the one or more components 106and the one or more user devices 108. One or more users (not shown) canaccess the components 106 and the user devices 108 to generate, provide,and access medical-related data within the medical provider network 100.In some examples, the medical-related data may have been received by thetransformative integration engine 102 and retained for use by others ofthe components 106 and/or the user devices 108. The one or more userscan include, for example, first responders, medical care professionals,patients, or any other suitable type of user.

The first responder can include, for example, an emergency medicaltechnician, a firefighter, a police officer, a member of the military, adesignated medical volunteer, and the like. In the context of thisspecification, the first responder is typically dispatched or directedto the scene of an accident in order to provide medical support tovictims.

In some examples, the first responder provides medical-related data tothe transformative integration engine 102 using one of the one or moreuser devices 108 as part of responding to the dispatch. For example, inone example, the first responder arrives at a car accident, identifies avictim by one more means of identification (e.g., a driver's licensenumber, name, address, etc.), and shares the identifying informationwith the transformative integration engine 102 via one of the one ormore user devices 108 (e.g., a mobile phone, a radio, or othercommunication device). In return, the transformative integration engine102 can facilitate the provision of medical-related data associated withthe victim to the first responder. In this manner, the first respondercan be informed of, for example, the medical history and otherconsiderations while providing medical treatment to the victim.

The first responder can provide and/or receive the medical-related datavia the one or more user devices 108. Thus, at least in this example,the one or more user devices 108 may operate according to a privateand/or proprietary network or protocols. In other examples, the one ormore user devices 108 may operate on public networks. In any case,however, the transformative integration engine 102 can have access tothe one or more components and can communicate with them via a public,private and/or proprietary network or protocols. The use of one or moreprivate and/or proprietary protocols can promote secure transfer ofmedical-related data.

In some examples, the one or more users can include a medical careprofessional and/or care provider. The medical care professional and/orcare provider can provide one or more medical-related services,including, for example, examination, surgery, diagnosis, consultation,counseling, scheduling of visits, handling of protected health recordinformation, payment handling, coordination of care, management of care,and the like. In some examples, the medical care professional isassociated with the medical care facility 110. In some examples, themedical care professional is a doctor, a nurse, a surgeon, a physicaltherapist, a medical assistant, a facility staff person, anadministrative employee, or any other person who utilizesmedical-related data for treatment of patients. In this example, themedical care professional utilizes some of the one or more user devices108 to send medical-related data to, and/or receive from, thetransformative integration engine 102, medical-related data. In thismanner, the medical care professional can receive updates, statuses,progress, and the like relating to patients of the.

In some examples, the one or more users can include a patient. Thepatient can be a patient of the medical care facility 110, the firstresponder, and/or the medical care professional. The patient can includeone that has expressly or implicitly authorized the medical carefacility 110, the first responder and/or the medical care professionalto access and record medical-related data pertaining to servicesprovided to the patient.

Referring next to FIG. 2 , a block diagram of an example of a medicalprovider network 200 is shown. The medical provider network 200 includesa transformative integration engine 202. The transformative integrationengine 202 is an example of the transformative integration engine 102discussed with reference to FIG. 1 . The medical provider network 200also includes one or more generation components 204. In particular, theone or more generation components 204 includes a medical equipmentcomponent 206, a lab systems component 208, a business component 210, aclinical component 212, and other generation component 214. The one ormore generation components 204 are examples of the one or morecomponents 106 discussed with reference to FIG. 1 . The one or moregeneration components 204 are configured to provide medical-related datato the transformative integration engine 202. In some examples, themedical-related data may pass to the transformative integration engine202 via a messaging hub 236. In some examples, only a portion of themedical-related data is passed via the messaging hub 236, while otherportions are passed directly to the transformative integration engine202 without first passing over the messaging hub 236.

Generally, the one or more generation components 204 includes anysuitable device or system capable of generating medical-related data inthe context of a medical provider network. For example, the othergeneration component 214 may include a sensor on a door in a hospital,and the medical equipment component 206 may include a sophisticatedcomputer-controlled laser surgery device. In either case, eachgeneration component generates some type of medical-related data. Forexample, the medical-related data provided by the sensor may be used toaddress security concerns or assessing heating, ventilating, and airconditioning (HVAC) costs for the hospital. The medical-related dataprovided by the laser surgery device may have been provided whileoperating on a patient and may then be used by other doctors in thefuture to decide how to use the device on their own patients.

As discussed in further detail herein, medical-related data generated bythe one or more generation components 204 can be of a variety offormats, some of which may be proprietary. For example, a singlecomponent can generate data in multiple formats, different componentscan generate data in different formats, and/or different component typescan result in generation of data in different formats. In someinstances, formatting of a data can depend on a service having beenprovided, a user initiating data generation, a destination to receivethe data, a location at which a service was provided, etc. In someexamples, a typical medical provider network includes thousands ofgeneration components producing data in hundreds of formats. In order toharness the power that comes from such a large amount of medical-relateddata to make informed health care decisions, it is desirable that all,or at least a large portion of the data, is shared. Use of thetransformative integration engine 202 in accordance with techniquesdescribed herein may achieve this design—making large amounts of data,in many different originating format, available to doctors, nurses,patients, administrators, and third parties, via one or more interfaces.

While the one or more generation components 204 are illustrated adjacentto each other, it is understood that each may be located within onefacility or that the components may be spread out among many facilities.In addition, in some examples, the one or more generation components 204belong to different medical provider organizations.

Turning now to the medical equipment component 206, this componentincludes any medical machine, contrivance, implant, or other similarrelated article, that is intended to aid in the diagnosis, monitoring,or treatment of medical conditions. This includes, for example,diagnostic equipment, including medical imaging machines (e.g.,ultrasound machines, magnetic resonance imaging (MRI) machines, positronemission tomography (PET) scanners, computed tomography (CT) scanners,and x-ray machines); therapeutic equipment (e.g., infusion pumps,medical lasers, and laser-assisted in situ Keratomileusis (LASIK)lasers); life support equipment (e.g., medical ventilators, anestheticmachines, heart-lung machines, extracorporeal membrane oxygenation(ECMO) machines, and dialysis machines) and/or medical monitors tomeasure patient's medical state (e.g., electrocardiography (ECG),electroencephalography (EEG), blood pressure machines, and equipment formonitoring dissolved gases in the blood). Each of the above-listedcomponents generates medical-related data that is provided to thetransformative integration engine 202.

As illustrated, the medical equipment component 206 includestransformative adaptor 216. In some examples, the transformative adaptor216 is a device that transforms, translates, converts, or otherwiseadjusts output data from the medical equipment component 206. Forexample, a medical equipment component 206 can be a CT scanner thatoutputs its results in format A, but the majority of other CT scannersin the medical provider network output their results in format B. Thetransformative adaptor 216 may be implemented to convert or otherwiseadjust the results in format A to conform closer to format B. Forexample, the conversion from format A to format B may be performed usinga conversion rule, which may be user-define or learned. Thetransformative integration engine 202 may perform similar tasks as itrelates to all data generated within the medical provider network 200.In this manner, the transformative adaptor 216 can perform an initialstep in the process of transformation, translation, conversion, oradjustment of the output of the medical equipment component 206. In someexamples, the transformative adaptor 216 is implemented in hardware,software, or any suitable combination of both. In some examples, othertransformative adaptors (not shown) may be implemented within others ofthe one or more generation components 204. In some examples, the medicalequipment component 206 may not include the transformative adaptor 216.

The lab systems component 208 includes any suitable medical laboratoryequipment or system that is intended to analyze material related topatient care. This includes, for example, medical laboratory equipmentthat analyzes blood, urine, and genes; electric microscopes;ultracentrifuges; data collection devices, including Kymographs, sensorsconnected to a computer to collect data; monitoring devices; computersused by clinicians to report results of lab tests, and other similarmedical laboratory equipment. Each of the above-listed componentsgenerates medical-related data that is provided (directly or indirectly)to the transformative integration engine 202. The provided data canfurther include an identification of a patient and/or otherpatient-pertinent information (e.g., actual or suspected diagnosisand/or demographic information).

The business component 210 includes any suitable computing devices usedfor business-related purposes with respect to the medical providernetwork 200. For example, the business component 210 can be configuredto receive inputs by employees of a hospital to prepare medical-relateddata including business-related data relating to eligibility andregistration of patients, scheduling and throughputs, general supplychain materials management, pharmacy supply chain materials management,human resources, financial documentation and logging, buildingoperations, information technology systems, marketing, budgeting, andother similar business-related purposes. In some examples, thebusiness-related information is auto-generated or populated by thebusiness component 210. At least a portion of such information isprovided to the transformative integration engine 202.

The clinical component 212 includes any suitable computing device usedin research, treatment, and care of patients. For example, the clinicalcomponent 212 is used to generate medical-related data includingclinical data, which may further include an identification of a patientand/or other patient-pertinent information. For example, the clinicalcomponent 212 is used by nurses, technicians, doctors, and/or otherindividuals associated with a hospital, clinic, lab, or other similarentity to prepare clinical data. Clinical data includes, for example,output relating to computerized physician order entry (CPOE), protectedhealth information for patients (i.e., a subset of medical-relateddata), dictations, lab results, lab requests, lab tests, orders formedical supplies, intake and checkout of patients, medical reports,clinical tests, clinical documentation, and other similar clinicalinformation. At least a portion of such information is provided to thetransformative integration engine 202. In some examples, the clinicaldata is auto-generated or populated by the clinical component 212. Theclinical component 212 and the business component 210 are often selectedfrom a similar group of computing devices.

As described herein, a notification service 238 shares a networkconnection with the messaging hub 236. The notification service 238 isconfigured to monitor medical-related data (e.g., medical messages) thatis passed over the messaging hub 236 and, from the monitored data,select certain portions to provide to one or more authorized users(e.g., patients, friends and family members of patients, medical careprofessionals, and other suitable authorized users).

Each of the one or more generation components 204 and the user device228 may include individual and/or shared storage systems, one or moreprocessors, a user interface, a network connectivity device, and one ormore ports. The storage system include memory that may be implemented,e.g., using magnetic storage media, flash memory, other semiconductormemory (e.g., DRAM, SRAM), or any other non-transitory storage medium,or a combination of media, and can include volatile and/or non-volatilemedia. The storage systems may also be configured to storecomputer-executable code or instructions for interacting with the userinterface and/or for one or more applications programs, such as anapplication program for collecting medical-related data generated by theparticular generation component.

The one or more processors may be configured to access the operatingsystem and application programs stored within the storage systems, andmay also be configured to execute such program code. The one or moreprocessors can be implemented as one or more integrated circuits, e.g.,one or more single-core or multi-core microprocessors ormicrocontrollers, examples of which are known in the art. In operation,the one or more processors can control the operation of the particularcomponent. The one or more processors may access and execute the programcode and at any given time.

The user interface can include any combination of input and outputdevices. In some instances, a user can operate input devices of the userinterface to invoke the functionality of the particular component oruser device. For example, the user interface may enable the user toview, hear, and/or otherwise experience output from component or userdevice via the output devices of the user interface. Examples of outputdevices include a display, speakers, and the like.

The network connectivity device may enable the component or user deviceto communicate with the transformative integration engine 202 and othercomponents or other user devices via one or more networks. The one ormore networks may include any suitable combination of cable, cellular,radio, digital subscriber line, or any other suitable network, which maybe wired and/or wireless. In some examples, the network connectivitydevice may enable the component or the user device to communicatewirelessly with various other components and/or the transformativeintegration engine 202. For example, the components may includecircuitry to enable data communication over a wireless medium, e.g.,using near-field communication (NFC), Bluetooth Low Energy, Bluetooth®(a family of standards promulgated by Bluetooth SIG, Inc.), Zigbee,Wi-Fi (IEEE 802.11 family standards), or other protocols for wirelessdata communication.

The one or more ports may enable the component or the user device toreceive medical-related data from one or more sensors. For example, aparticular port may include an interface for receiving data collectedfrom an ultrasound machine. The sensors may be any suitable type ofsensor to capture data. Such captured data may be shared with thetransformative integration engine 202 in accordance with techniquesdescribed herein. In some examples, the sensors may also be configuredto detect the component's or the user device's location and otherdetails about the component or the user device. In some examples, thecomponent and user device may include global positioning chips fordetermining a geolocation. Such geolocation information may be relevantto analyzing the medical-related data provided by the component or theuser device located at the geographic location.

The transformative integration engine 202 includes an aggregation engine218, an interoperability engine 220, an access management engine 222, aninterface engine 224, and a data store 226. Generally the aggregationengine 218 is configured to collect medical-related data of differentformats generated by the one or more generation components 204. Theaggregation engine 218 may also be configured to perform one or moreoperations on the collected data. For example, the aggregation engine218 may tag data, log data, perform protocol conversion, and may supportone-to-many communications. The collection may be asynchronous. In someexamples, the medical-related data has been saved locally in connectionwith the one or more generation components 204 in many different formatshaving many different data structures.

The aggregation engine 218 is configured to receive such diverse (or, inother embodiments, uniformly formatted) data and provide it to theinteroperability engine 220. The interoperability engine 220 isconfigured to perform one or more operations on the receivedmedical-related data and store it in the data store 226. For example,the interoperability engine 220 may perform semantic tagging andindexing of medical-related data. This may include extracting fieldvalues from data, categorizing data (e.g., by type of data,characteristic of patient, location of medical care facility,characteristic of medical care facility, and the like), anonymizing orpartially-anonymizing data, and the like. The interoperability engine220 may also include a high availability cache, an alerts engine and arules engine. In some examples, the interoperability engine 220 operatessynchronously.

From the interoperability engine 220, medical-related data flows to thedata store 226. The data store 226 (and any other data store discussedherein) may include one or more data stores, which may be distributedthroughout two or more different locations (e.g., present on differentdevices, which can include devices of different entities and/or a cloudserver). In some examples, the data store 226 includes a general datastore 230, an enterprise data store 232, and a clinical data store 234.Within each of the data stores 230, 232, and 234 is storedmedical-related data. Depending on the structure of the particular datastore, certain data stores may include rules for reading and writing.The data stores 230, 232, and 234 may include records, tables, arrays,and the like, which may be relational or non-relational. Depending onthe data store, records for individual patients, results of clinicalstudies, business and analytics information, output data from the one ormore generation components 204, and the like may be retained. The datawithin the data stores 230, 232, and 234 include elements or tags suchthat a particular data (e.g., for a single patient, doctor, diagnosis,type of doctor, type of treatment, patients matching a criteria, and thelike) can be retrieved.

The access management engine 222 is configured to manage access tofeatures of transformative integration engine 202, including access tothe medical-related data retained in the data store 226. For example,the access management engine 222 may verify that a user device such asuser device 228 is authorized to access the data store 226. To verifythe user device 228, the access management engine 222 may require that auser of the user device 228 input a username and password, have aprofile associated with the medical provider network, have paid asubscription fee associated with access to the data store 226, and thelike. The access management engine 222 may also verify that the userdevice 228 has an IP address or geographical location that correspondsto an authorized list, that the user device 228 includes a plug-in forproperly accessing the data store 226, that the user device 228 isrunning certain applications required to access the data store 226, andthe like.

The interface engine 224 is configured to retrieve the data from thedata store 226 and provide one or more interfaces for interacting withelements of the transformative integration engine 202. For example, theinterface engine 224 includes an interface by which an applicationrunning on user device 228 can access portions of data within the datastore 226

Turning next to FIG. 3 , a medical architecture stack 300 is shown. Insome examples, techniques relating management of medical-related dataare implemented in accordance with the medical architecture stack 300.And while the medical architecture stack 300 is illustrated as having aparticular structure, it is understood that other structures, includingthose with more or less layers than illustrated, is within the scope ofthis specification. In some examples, the medical architecture stack 300is implemented across a medical provider network having a plurality ofsystems belonging to the same medical provider organization or spreadacross different medical provider organizations. Thus, the medicalarchitecture stack 300 can be used to integrate different systems ofdifferent organizations, entities, and the like and to provide a fluidsharing of information among elements within the medical providernetwork and without the medical provider network. In some instances, amulti-layer part of the medical architecture stack 300 is implemented ata single system or device within a medical provider network.

The different layers of the medical architecture stack 300 will bedescribed generally with reference to FIG. 3 and in detail withreference to subsequent figures. The medical architecture stack 300includes a receiving layer 302 as the bottom-most layer. The receivinglayer 302 includes receiving medical-related data from elements thatshare medical-related data with other elements within an aggregationlayer 304. For example, as detailed herein, the receiving layer 302 caninclude receiving medical-related data from generation components thatgenerate medical-related data. As such, the receiving layer 302 is wheremedical-related data that has been created is received. In someexamples, the data within the receiving layer 302 may be in its rawformats. For example, output from an MRI machine may be received withinthe receiving layer 302. The output may then be transmitted to theaggregation layer 304. In some examples, components of the receivinglayer 302 may have complimentary layers to facilitate data transfer. Forexample, the components may include a data generation and/or a datatransmission layer for providing data to the receiving layer 302.

Elements of the aggregation layer 304 aggregate the medical-related datagenerated by the elements of the receiving layer 302. For example, theelements of the aggregation layer 304 may include aggregation enginesthat collect data from generation components located within thereceiving layer 302. Such aggregation may be performed periodically, inresponse to a user request, according to a schedule, or in any othersuitable manner. In some examples, data of the aggregation layer 304 maybe aggregated according to input and/or rules and may aggregate acrossrecords pertaining to, e.g., a same medical care professional, medicalcare facility, entity, time period, patient characteristic (e.g.,demographic characteristic or condition), patient health outcome, andany other suitable input and/or rules. Exemplary data being aggregatedcan include, e.g., diagnosis for particular patients and/or patientgroups, test results, treatment parameters or characteristics, healthoutcomes (e.g., side effect occurrence, mortality, readmissions, sepsis,etc.), pharmacy orders, patient record data, and the like. Theaggregation may include compiling the data, generating a distribution,generating a statistic pertaining to the data (e.g., average, median,extremum or variance), converting the data, transforming the data todifferent formats, and the like.

Next, the medical architecture stack 300 includes an active unified datalayer 308. Elements of the active unified data layer 308 receivemedical-related data from the elements of the other layers and storesuch data in a unified manner. In some examples, this may includestoring the data in a manner that allows for later searching andretrieval using a defined set of method calls, techniques, and orprocedures. For example, the data may be stored such that a differentapplication can access the data in a standard or unified manner. Thus,elements of the active unified data layer 308 may receive informationcollected or generated within the aggregation layer 304 and make certainadjustments to the data (e.g., translations, tagging, indexing, creationof rules for accessing the data, conversion of formatting of the data,generation of compressed versions, and the like) prior to retaining thedata within one or more data stores accessible within the active unifieddata layer 308.

The medical architecture stack 300 also includes an access managementlayer 310, which can include an audit/compliance layer 312 and/or anagency layer 314. The access management layer 310 includes elements tomanage access to the medical-related data. For example, the accessmanagement layer 310 may include elements to verify user logincredentials, IP addresses associated with a user device, and the likeprior to granting the user access to data stored within the activeunified data layer 308.

The audit/compliance layer 312 includes elements to audit other elementsof the medical architecture stack 300 and ensure compliance withoperating procedures. For example, this may include tracking andmonitoring the other elements of the access management layer 310.

The agency layer 314 includes an access location (e.g., a virtualprivate network, a data feed, or the like) for elements of agencies thatare interested in the operations of the medical provider network inwhich the medical architecture stack 300 is implemented. For example,the agency layer 314 may allow a governmental entity access to someelements within the medical architecture stack 300. This may be achievedby providing the governmental entity a direct conduit (perhaps by avirtual private network) to the elements of the access management layer310 and the medical-related data within the active unified data layer308. The audit/compliance layer 312 and the agency layer 314 aresub-layers of the access management layer 310.

The medical architecture stack 300 also includes interface layer 316.The interface layer 316 provides interfaces for users to interact withthe other elements of the medical architecture stack 300. For example,medical care providers, patients, medical care administrators, andothers belonging to the medical provider network may utilize one or moreuser devices (interacting within the application/device layer 320) toaccess the medical-related data stored within the active unified datalayer 308. In some examples, the users may be unrelated to the medicalprovider network (e.g., ordinary users who are not patients, familymembers of patients, research universities, for profit and non-profitresearch organizations, world health care organizations, disaster relieforganizations, and the like) and may use applications (not shown) toaccess the elements within the medical architecture stack 300 via one ormore interfaces (e.g., to access medical-related data stored within theactive unified data layer 308). Such applications may have beendeveloped by the medical provider network or by third-parties

Finally, the medical architecture stack 300 includes application/devicelayer 320. The application/device layer 320 includes user devices andapplications for interacting with the other elements of the medicalarchitecture stack 300 via the elements of the interface layer 316. Forexample, the applications may be web-based applications, patientportals, doctor portals, mobile applications, widgets, and the like foraccessing the medical-related data. These applications may run on one ormore user devices. The user devices may be any suitable user device asdetailed herein.

Turning next to FIG. 4 , a diagram 400 is shown that depicts a portionof the medical architecture stack 300 according to an embodiment of theinvention. In particular, the diagram 400 includes the receiving layer302, the aggregation layer 304, the third-party aggregation layer 306,and a portion of the active unified data layer 308. The receiving layer302 receives data from one or more components 410-418. The components410-418 are examples of the one or more generation components 204. Thecomponents 410-418 may be spread across multiple medical care facilitieswithin a single or multiple medical provider organizations. For example,the component 410 may be located at a hospital, the component 412 may belocated at a clinic, the component 414 may be located at urgent carefacility, and so forth. Additionally, the hospital may belong to a firstmedical provider organization, while the clinic may belong to a secondmedical provider organization, both of which or part of which may belongto the same medical provider network. In some examples, the components410-418 may include complimentary layers to facilitate datatransmission. For example, the components 410-418 may include atransmission layer, generation layer, and/or a receiving layer tocommunicate data at the receiving layer 302 and, in some examples,receive data from the receiving layer 302.

In some instances, two or more of the components 410-418 generatemedical-related data according to different formats. The medical-relateddata can then be transformed, translated, or otherwise adjusted beforean aggregation engine 420 (e.g., the aggregation engine 218) or athird-party aggregation engine 422 (e.g., the aggregation engine 218)collects the medical-related data. In some examples, the adjustmenttakes place within the receiving layer 302. Thus, an adaptor 424 isassociated with the component 412 located in the receiving layer 302.The adaptor 424 is an example of the transformative adaptor 216. Theadaptor 424 is implemented, as appropriate, in hardware, software, orany suitable combination of both. For example, the transformativeadaptor 216 may be a bolt-on adaptor that adjusts medical-related dataas such data leaves the component 412.

Other adaptors, such as adaptor 426 and adaptor 428, are implementedwithin the aggregation layer 304. These adaptors can function in asimilar manner as the adaptor 424. In some examples, the medical-relateddata provided by the component 414 is transmitted through adaptor 426prior to being directed to the aggregation engine 420. Themedical-related data provided by the component 416 is transmittedthrough the aggregation layer 304 and/or enters the aggregation engine420 without having first traveled through an adaptor. Themedical-related data provided by the component 418 is transmittedthrough the aggregation layer 304 and through adaptor 428. In someexamples, the component 418 provides for streaming of medical-relateddata. The medical-related data provided by the component 410 istransmitted directly to the third-party aggregation engine 422.

In some examples, medical related data provided by the components410-418 may be communicated via a messaging bus 430 (e.g., the messagingbus 236). The medical-related date, in the form of medical messages maybe put on the messaging bus 236 by the one or more components, by theaggregation engine 420, by the third-party aggregation engine 422, andby any other suitable device capable of generating medical messages. Insome examples, medical messages are taken off of the messaging bus 430by the aggregation engine and/or by one or more listeners described inmore detail herein. Thus, circle 432 indicates that medical-related data(e.g., medical messages) may flow from the messaging bus 430 to anotification service and processed in accordance with techniquesdescribed herein.

The aggregation engine 420 and the third-party aggregation engine 422function in a similar manner. In some examples, the third-partyaggregation engine 422 is operated by a different entity than the entitythat operates the aggregation engine 420 and may belong to differentmedical provider organizations or a different medical provider network.This may be because the medical-related data collected by thethird-party aggregation engine 422 differs in some way from themedical-related data collected by the aggregation engine 420. In anyevent, the aggregation engine 420 is configured to perform integrationof medical-related data, including generic integration. For example, theaggregation engine 420 performs one or more operations onmedical-related data including tagging, logging, and protocolconversion. The aggregation engine 420 also supports one-to-manycommunications of medical-related data. In some examples,medical-related data flows between the aggregation engine 420, thethird-party aggregation engine 422, and some of the components 410-418and elements of the active unified data layer 308.

Referring next to FIG. 5 , a diagram 500 is shown that depicts a portionof the medical architecture stack 300 according to an embodiment of theinvention. In particular, the diagram 500 includes the active unifieddata layer 308 and a portion of the access management layer 310. Theactive unified data layer 308, as illustrated in the diagram 500,includes an interoperability engine 502 (e.g., the interoperabilityengine 220), a transaction management collection engine 504, a datastore integrity engine 506, and a data store 508 (e.g., the data store226). Generally, the interoperability engine 502 receivesmedical-related data from elements within the aggregation layer 304(e.g., from the aggregation engine 420) and performs one or moreoperations with respect to the medical-related data. Theinteroperability engine 502 also facilitates storage of at least aportion of the processed information in the data store 508.

The transaction management collection engine 504 is implemented as partof the transaction management engine 104. The transaction managementcollection engine 504 is configured to generate message indicatorsidentifying flows of data by and between elements of a medical providernetwork implemented using the techniques described herein. The flows ofinformation include messages which include medical-related data, and themessage indicators include unique message identifiers that can be usedto identify the messages. The unique message identifiers includeinformation that can be used to uniquely identify the messages. Forexample, a unique message identifier for a particular message caninclude a concatenation of the following information stored in a table:a source application, a facility, a message type, and a message controlidentification (ID). The unique message identifier can also be themessage control ID. The unique message identifier may be created asmessages including medical-related data are transmitted from theaggregation layer 304. The table may be stored in association with thetransaction management platform 528.

In some examples, the table also includes information for tracking theprogress of the message from an origination node to a destination node.For example, typically when a message (e.g., any communication of data)is first received by the transformative integration engine 102 (e.g.,the interoperability engine 502), the transaction management engine 104(e.g., the transaction management collection engine 504 of thetransaction management engine 104) may generate a unique identifier forthe message in order to track that message as it moves throughout themedical provider network. The unique identifier may be included in theheader of the message such that when the next node (e.g., component,device, server, etc.) after the transformative integration engine 102receives the message, that node can report back to the transactionmanagement engine 104 that it saw the message. In this manner, thetransaction management engine 104 may enable end-to-end tracking ofmessages for the life of the message. In one example, the messages arepharmacy orders. The pharmacy orders may be generated by a user enteringin the orders at one of the components. The orders may be received bythe transformative integration engine 102 and integrated into thesystem. In some examples, the transaction management engine 104 may benotified that the orders have been received and may therefore beconfigured to generate message IDs for each order. These message IDs maythen be associated with each of the orders. As the orders continue tomove throughout the medical provider network (e.g., away from thetransformative integration engine 102), the transaction managementengine 104 may be track their movement using the message IDs. If one ofthe orders does not make it to its destination, the transactionmanagement engine 104 (or part of the transaction management platform528) may determine why the order was stopped. In some examples, thiscause may be hardware related (e.g., an unplugged Ethernet cable, abroken router, etc.), software related (e.g., a router routing to thewrong location), or any other reason for orders not arriving at theircorrect destination.

In some examples, the transaction management engine 104 (e.g., thetransaction management collection engine 504 of the transactionmanagement engine 104) may receive the message and/or message identifierdirectly from one of the components 410-418. For example, one of thecomponents 410-416 may be configured to generate the unique messageidentifier and/or communicate directly with the transaction managementengine 104. The message also may travel via one or more intermediateodes on its way to the destination node. In some examples, a node is acomponent such as the components 410-418, which may be running anapplication. In some examples, the unique identifier and the routing ofthe message to its destination may stored in a table that also includes:a geolocation of each node, a network from which the message originated,a type of node, the unique node identifier, and a time associated withthe message leaving the origination node. In some examples, thetransaction management collection engine 504 provides unique messageidentifiers to other elements of the medical provider network to monitorthe messages as they move throughout the medical provider network. Thetransaction management collection engine 504 also provides a portion ofthe unique message identifiers to a transaction management platform(indicated by circle 528) for further analysis of the messageidentifiers. Such analysis may include reconciliation of lost messages,latency reporting, audit management and compliance, and other suchanalyses.

As mentioned previously, the interoperability engine 502 is configuredto store medical-related data in the data store 508. A plurality ofsub-engines 510-516 of the interoperability engine 502 are configured toperform operations relating to storing medical-related data in the datastore 508.

The interoperability engine 502 includes a tagging engine 510 configuredto perform semantic tagging and indexing of medical-related data. Thetagging engine 510 therefore is configured to receive medical-relateddata, read metadata associated with the medical-related data,semantically scan the content of the medical-related data, and associateone or more tags with the medical-related data. The tagging engine 510may therefore have access to hundreds, thousands, or even more possibletags. These tags may have been input by users, learned, pre-defined,generated by outside third-party mapping sources, and/or gathered fromother components and/or data stores of the medical provider network. Forexample, if the medical-related data is a medical chart for a cancerpatient, the tagging engine may be configured to read any metadataassociated with the chart to determine which tags may be appropriate toassociate with the chart. From the metadata the tagging engine 510 maydetermine that the chart is for a cancer patient by reading metadataindicating that an author field is populated with the name of anoncologist who prepared the medical chart. The tagging engine 510 mayhave access to other data to compare the analyzed metadata against(e.g., to identify that the author's name corresponds to Dr. Brown whois an oncologist). Other examples, of metadata that may be included inone or more fields include author, document type, creation time anddate, last update time and date, upload time and data, geographiclocation, unique ID associated with the medical care provider or medicalcare facility where the data originated, and other similar fields. Thetags may be stored in association with the medical-related data (e.g.,the chart) and/or may be stored independent from the medical-relateddata but include an identifier such that when searching tags themedical-related data may be capable of population.

Continuing with the example from above, if the medical-related data is amedical chart for a cancer patient, the tagging engine 510 may beconfigured to read the content of the chart to determine which tags maybe appropriate to associate with the chart. For example, this maycomprise analyzing the content of the chart (i.e., individual pages)semantically to look for artifacts (e.g., keywords, phrases, and thelike) in the content. These artifacts may be identified by the taggingengine 510 and used to decide which tags to associate with the document.In some examples, semantic scanning may involve filtering out words(e.g., articles, such as “a” and “the”), phrases, and the like. Similarto the reading of metadata, the tags may be pre-defined, user-defined,learned, and the like. In some examples, reading metadata associatedwith messages may provide meaning and/or give context to the particularrecord of medical-related data. This meaning and/or context may assistthe tagging engine 510 to determine one or more tags to associate withthe medical-related data. The tags may be chosen, for example, based onvalues of particular fields in the data, detecting a frequency of one ormore words in a document or metadata and/or of a set of related words(e.g., tagging a record with “cancer” upon detecting words such astumor, metastasize, chemotherapy, radiation, oncology, malignant, stage3, etc.). In this manner, the tagging engine 510 may also index portionsof the medical-related data within one or more data stores of the datastore 508. In some examples, the such indexing may be based in part onthe selected tags.

The interoperability engine 502 also includes an reports engine 512configured to generate one or more reports or alerts based onmedical-related data. For example, the reports engine 512 may generatereports when certain types of medical-related data are received or whenmedical-related data with certain characteristics is received. Thereports engine 512 may also generate alerts. The reports and/or alertsgenerated by the reports engine 512 may be outputted in the form of oneor more communications to an administrator, an authorized user, or othersimilar user via a user device. Such communications include, forexample, signals, sirens, electronic notifications, popups, emails, textmessages, and the like. Content of such communications may includeinformation characterizing a care provider's or institution'sperformance in providing care, efficiency and/or patient outcomes;identifying concern patient-data patterns; identifying losses ofmedical-related data; and the like. In some examples, the content ispresented in the form of one or more documents, tables, figures, charts,graphs, and the like. For example, the reports engine 512 may output areport to a hospital administrator indicating the patient outcomes forthe hospital for the last year. This report may be presented in the formof a graph.

The interoperability engine 502 also includes a rules engine 514configured to create and manage business rules, health-response rules,alert/reports rules, data-formatting rules, data-sharing rules,transmission rules, aggregation rules, user authorization rules,law-based rules, cost-based rules, and other similar rules. Such rulesmay be user-defined, fixed, learned by elements of the medical providernetwork, and any combination of the foregoing. For example, a businessrule may be defined by a hospital administrator and relate to supplychain management and visualization and optimization of planning andscheduling. The rules can apply across different medical carefacilities, medical conditions, patient types, geographic areas, and/orentities. Finally, the interoperability engine 502 includes anapplication engine 516 configured to provide service-orientedarchitecture web services.

The data store 508 includes an electronic health record information(EHRI) data store 518 (“the record data store 518”), a general datastore 520, an enterprise data store 522, a clinical data store 524, anda streaming caching storage 526. While the data store 508 is illustratedas including a fixed number of data stores and storage elements, it isunderstood that the data store 508 can include any suitable number ofdata stores and storage elements, including more than illustrated orless than illustrated.

In some examples, a data query script is provided to query a first datastore and/or to obtain data for populating a data store. Such scriptcould query a data store described herein (e.g., data store 508) and/orcould be used to obtain data to populate a data store described herein(e.g., data store 508). In one instance, the script is configured to berepeatedly executed, so as to repeatedly draw data from a source datastore. The retrieved data can then be formatted, filtered, sorted and/orprocessed and then stored, presented and/or otherwise used. In thismanner, the script can be used to produce streaming analytics.

In some instances, the data query script, when executed, identifies eachof the data stores of interest. Identifying the data stores of interestinvolves identifying at least a portion of data from the data storessimultaneously and/or sequentially. For example, the script can identifycorresponding data stores (e.g., or components of a single data store ormultiple data stores) that pertain to one or more similar variables(e.g., pertaining to a similar medical condition, treatment, physicianor geographical region) but that differ in one or more other variables(e.g., institution affiliation). Once the portion of the data from thedata stores is identified, a representation of the identified data canbe output to one or more files (e.g., Extensible Markup Language (XML)files) and/or in one or more formats. Such outputs can then be used toaccess the data within one or more relational database accessible usingStructured Query Language (SQL). Queries made using SQL can be madesequentially or in parallel. Results from an SQL query may be stored ina separate database or in an XML file that may be updated either in partor as a whole. The data query script may be executed periodically, inaccordance with a user-defined rule, in accordance with amachine-defined or machine-learned rule, and in other suitable manner.

Within the record data store 518 is retained medical-related dataincluding electronic health record information. In some examples, theinformation within the record data store 518 is organized according topatient identifying information. Thus, the record data store 518, insome examples, includes individually identifiable information. But itmay also include de-identified information.

Within the general data store 520 is retained medical-related data. Themedical-related data may be stored in a relational database format or inany other suitable format. Thus, the data within the general data store520 may be retained in a data structure that includes one or more tablescapable of accessing each other. The general data store 520 includescertain types of clinical information. For example, the general datastore 520 may include orderables and labs. In some examples, the generaldata store 520 includes medical-related data, including medical recordinformation associated with patients, patient insurance information,demographic information of the patients, and at least some financialinformation of the patients. In some examples, the general data store520 includes all medical-related data needed for clinical decisionmaking as discussed herein. In some examples, the general data store 520includes a subset of the information that is included in the enterprisedata store 522.

Within the enterprise data store 522 is retained medical-related data ina relational database format. Thus, the data within the enterprise datastore 522 may be retained in a data structure that includes one or moredata structures (e.g., tables) capable of accessing each other. Theenterprise data store 522 is an example of an enterprise data warehouse.In the enterprise data store 522 is joined many different types ofmedical-related data. For example, clinical, financial, andadministrative information are stored in the enterprise data store 522.In some examples, the enterprise data ware house 522 includesmedical-related data pertaining to clinical decision making as discussedherein and other medical-related data typically used by conventionalbusiness concerns. Thus, in the enterprise data ware house 522 may becombined clinical decision making information and business operationsinformation. For example, the enterprise data warehouse 522 may includefinancial information, supply chain information, business unitsorganization information, clinical organization information, humanresources information, and any other suitable type of informationrelevant to the operations of a medical care organization as a businessconcern, whether non-profit or for profit.

Within the clinical data store 524 is retained medical-related data in anon-relational database format. Thus, the data within the clinical datastore 524 may be retained in a structure other than tables. Suchstructure may be appropriate for large and complex data sets includingmedical-related data. In some examples, the clinical data store 524 (orany other data store) may be a unified system for clinical information,which may include: a document-centric, schema-agnostic, structure-aware,clustered, transactional, secure, database server with built-in searchand a full suite of application services. An example of such a unifiedsystem may be Marklogic. The clinical data store 524 can support dataaggregation, data organization, data indexing, data tagging and mappingto semantic standards, concept matching, concept extraction, machinelearning algorithms, concept discovery, concept mining, andtransformation of personal medical record information. In some examples,clinical data store 524 includes medical-related data pertaining toclinical decision making (similar to the general data store 520) asdiscussed that is organized and accessed in a different manner. Forexample, the medical-related data within the clinical data store 524 maybe optimized for providing and receiving information over one or morehealth information exchanges. In some examples, such organization maymean that less demographic information is associated with each patient,or only a portion of financial information is associated with eachpatient. In some examples, the clinical data store 524 includes a subsetof the information that is included in the enterprise data store 522.

Finally, in some examples, the streaming caching storage 526 is astreaming data cache data store. As discussed previously, certaincomponents of the components 410-418 may support streaming data to othercomponents or user devices. The streaming caching storage 526 is alocation where streaming data can be cached. For example, assume thatthe component 418 is an MRI machine operated by a technician in hospitalA and that a doctor using a computer in hospital B desires to view alive or substantially live stream of the MRI results. The component 418can send a portion of data to the streaming caching storage 526 whichcan retain the portion of the data for a certain period of time (e.g., 1day). Thus, the streaming caching storage 526 is configured to cachedata that can be streamed.

The diagram 500 also includes data store integrity engine 506. In someexamples, the data store integrity engine 506 is configured to ensureintegrity of the information within the data store 508. For example, thedata store integrity engine 506 applies one or more rules to decidewhether information within all or part of the data store 508 should bescrubbed, removed, or adjusted. In this manner, confidence is increasedthat the information within the data store 508 is accurate and current.

FIG. 6 shows a diagram 600 which depicts a portion of the medicalarchitecture stack 300 according to an embodiment of the invention. Inparticular, the diagram 600 includes the access management layer 310,the audit/compliance layer 312, the agency layer 314, and a portion ofthe interface layer 316.

The access management layer 310, as illustrated in the diagram 600,includes an access management engine 602. The access management engine602 is an example of the access management engine 222. Generally, theaccess management engine 602 can be configured to manage access toelements of the transformative integration engine 202 by differentcomponents, applications, and user devices.

The access management engine 602 within the access management layer 310also provides functionality similar to an operating system. For example,the access management engine 602 includes a plurality of enginesconfigured to manage different aspects of interacting with elements ofthe medical provider network. For example, a user who desires to accessportions of medical-related data retained in the data store 508, may doso by interacting with the access management engine 602 using one ormore applications (not shown). Thus, the access management engine 602includes a variety of engines to enable such interaction. The enginesinclude, for example, an authentication access engine 604, a loginengine 606, a user preference engine 608, a security engine 610, ananalytics and search engine 612, a data access engine 614, an updateengine 616, a streaming data engine 618, and a billing engine 620. Thedifferent engines of the access management engine 602 can defineroutines, protocols, standards, and the like for interacting withelements of the medical provider network.

Beginning first with the authentication access engine 604, theauthentication access engine 604 evaluates the rules and conditionsunder which users may access elements of the medical provider network;in particular, the conditions under which users may accessmedical-related data within the data store 508. These rules andconditions may be user-defined (e.g., by an administrator or reviewer),learned over time, and/or may be dynamically updated and/or evaluatedbased on characteristics of the user or the user's device attempting toaccess the medical provider network. The rules and conditions mayindicate the types of users who have particular types of access withinthe medical provider network. For example, hospital administrators mayhave a different type of access from a patient. The type of access mayalso relate to the degree to which data is identified/de-identified. Forexample, a doctor to whom a release has been given, may have access toall of a patient's medical record. Similarly, a researcher may haveaccess to the records for many patients, so long as the records are donot include identifying information. In some examples, a user desiringaccess to medical-related data provides certain identifying informationand the authentication access engine 604 authenticates an identity ofthe user. For example, suppose the user is a doctor and the access is tomedical charts for one of the doctors patients. To authenticate thedoctor's identity, he or she provides identifying information and oncevalidated can be granted access to elements of the medical providernetwork where such information may be stored.

The login engine 606 evaluates the rules and conditions under whichusers are able to log in to the medical provider network or accessapplications associated with the medical provider network. These rulesand conditions may be user-defined (e.g., by an administrator), learnedover time, and also may be dynamically updated and/or evaluated based oncharacteristics of the user or the user's device attempting to accessthe medical provider network. Thus, while the authentication accessengine 604 evaluates the rules to determine which users may access themedical provider network, the login engine 606 evaluates the particularcredentials, profiles, etc. of the users. For example, the login engine606 can confirm that an entered username (e.g., and password), providedbiometric data or code or identifier in a scanned tag or badge matchesthat in an authorized user data structure.

The login engine 606 evaluates one or more user profiles associated witheach authenticated user. In some examples, a user profile includes ausername, password, and other information associated with the user. Forexample, a user profile may indicate characteristics about the user(e.g., that the user is patient belonging to a particular doctor, thatthe user is an employee belonging to a particular medical care facility,that the user is a vendor seeking access to certain portions of themedical provider network, that the user is a doctor having a particularspecialty, that the user is a scheduler who belongs to a clinic, andother characteristics).

The user preference engine 608 evaluates the rules and conditions underwhich user are able to store and update one or more user preferencescorresponding to access of the medical provider network or access toapplications associated with the medical provider network. These rulesand conditions may be user-defined (e.g., by the user or administrator),and may include rules for default preferences. For example, using theuser preference engine 608, a user may indicate a format in which theuser prefers to receive outputted information, display characteristicsof a graphical user interface associated with the user, and othersimilar user preference settings. For example, the user may indicatethat certain types of reports and/or alerts are to be sent to the user.

The security engine 610 evaluates the rules and conditions for ensuringthe security of access to the elements of the medical provider network.In some examples, these rules and conditions are determined byadministrators of the medical provider network. In some examples, thesecurity engine 610 provides a plurality of computer virus protectionservices. These services can be called up and implemented when accessingthe medical provider network or accessing applications associated withthe medical provider network. The rules and conditions may be based onroles, based on profiles, based on domains, and any other suitablesecurity configuration. For example, because the medical providernetwork may include sensitive medical-related data, the security engine610 may enforce a domain-based rule that protects certain sensitiveinformation (e.g., identifying information).

The analytics and search engine 612 evaluates the rules and conditionsunder which users can search for data within the medical providernetwork and access analytics relating to the medical provider network.In some examples, these rules and conditions are user-defined or learnedover time in accordance with search engine optimization techniques. Forexample, the analytics and search engine 612 is used to search withinthe data store 508 for particular medical-related data. The analyticsand search engine 612 supports any conventional searching algorithms.For example, the search engine 612 can be used to search within variousfields and potential field values (e.g., Hospital field, state field,specialty field, diagnosis field, health outcome field, doctor field).In some examples, search engine 612 can provide analytics, such asstatistics, graphs, distributions and/or comparative analysis pertainingto particular entities and/or medical characteristics. Such informationmay be selected by a user and presented on a user interface.

The data access engine 614 evaluates the rules and conditions underwhich users may operation in order to access particular medical-relateddata within the data store 508. In some examples, these rules andconditions are user-defined or learned over time. For example, the dataaccess engine 614 may indicate the routines, subroutines, or other logicneeded for an application to access certain portions of the data store508. For example, while the authentication access engine 604 and thelogin engine 606 may manage which users can access parts of the medicalprovider network, the data access engine 614 may manage howauthenticated users access data within the data store 508. To this end,the data access engine 614 may enforce and/or evaluate certain rulesmanaging how users access different components of the medical providernetwork. In some examples, the data access engine 614 may be used toactually access data within the data store 508 (e.g., extract, download,or otherwise access). In some examples, the data access engine 614 maydefine procedures, protocols, and the like for accessing data. Theprotocols and procedures for accessing the data access engine 614 (likethe other engines of the access management engine 602) may be providedto developers in the form of a software development kit (SDK). SDKs mayenable developers write applications that can effectively communicatewith elements (e.g., the data store 508) of the medical providernetwork. In particular, applications that can access a portion of themedical-related data stored within the active unified data layer 308.

The update engine 616 evaluates the rules and conditions for providingupdates to other engines within the access management engine 602,plug-ins for applications that access the medical provider network, andfor other similar elements of the medical provider network. For example,updates may be generated at runtimes, at defined time intervals, uponrequest by a user, upon receiving a threshold quantity of new or changeddata. Once an update is performed, an interface may be refreshed, areport may be sent indicating that the update was successful orunsuccessful, or the like.

The streaming data engine 618 defines the rules and conditions forenabling streaming of medical-related data between components and userdevices of the medical provider network. For example, the streaming dataengine 618 may enable the component 414 to stream medical-related data.Streamed data may include live or substantially live audio or videofeeds, results of medical tests, output from medical equipment ordevices, and any other suitable type of medical-related data capable ofbeing streamed. In some examples, the data may be streamed to othercomponents or user devices within the medical network or outside themedical network. In order to establish a streaming transmission, thestreaming data engine 618 may identify a streaming destination and astreaming origin. Next, the streaming data engine 618 may pair the twoand enable streaming. This may include allocated bandwidth within one ormore network devices associated with the medical provider network. Thestreaming data engine 618 may also adjust the quality of the streamingdata based on the availability of bandwidth. In some examples, thestreaming data engine 618 may receive incoming streams (and continuouslypresent the stream or monitor for particular data (e.g., exceeding athreshold, exhibiting an above-threshold change, having a particularvalue)).

The billing engine 620 evaluates the rules and conditions under whichapplications and users that access the medical provider network arebilled. For example, the billing engine 620 may include a variety ofdifferent charging rules to be applied to applications and users. Anexample rule indicates that applications or users will be charged on anhourly basis, another indicates that applications or users will becharged on a data transfer basis in terms of bytes, and anotherindicates that the applications or users will be charged a single amountfor unlimited use. The billing engine 620 also indicates, not only howapplications and users are charged, but also how they billed (e.g.,periodically, directly to users, to an organization, etc.). The billingengine 620 may also indicate how medical bills are calculated, compiled,and determined for users of the medical provider services and includethe procedures for accessing one's bill. For example, the billing engine620 may enforce billing structures rules for certain services providedby medical care professionals at medical care facilities. The billingengine 620 may also define the rule under which users (e.g., patients,doctors, nurses, etc.) may access their own bills and bills associatedwith others. In some examples, this may include stripping away certainprotected-health information, identifying information, and the like. Theengines of the access management engine 602 are accessed via theinterface layer 316 discussed later.

Within the audit/compliance layer 312 is located an access log engine622. The access log engine 622 evaluates the rules and conditions forlogging access to the medical provider network by users, applications,devices, and the like. Logging access includes, in some examples,logging data conventionally collected by access log engines running insimilar environments. Access log engine 622 can use this data togenerate and transmit reports, for example, to stakeholders of themedical provider network such that they can make informed decisionsregarding that is accessing the medical provider network and for whatpurposes.

Within the agency layer 314 is located an agency engine 624. The agencyengine 624 evaluates the rules and conditions under which agencies canaccess the medical provider network. For example, agencies that may usethe agency engine 624 include agencies to which the medical providernetwork provides compliance, tracking, or other reporting information.For example, the agency engine 624 may be used to track one or moreperformance indicators identified by a government agency, to reportoccurrences of infectious diseases, and to provide other similarreporting. Thus, in some examples, a government agency uses the agencyengine 624 to collect data pertaining to compliance of the medicalprovider network with one or more statutes or regulations. In someexamples, a university is an agency that uses the agency engine 624 tocollect data pertaining to one or more studies. In some examples, theagency engine 624 can identify one or more entities (e.g., governmentalagencies) that are to receive reports pertaining to medical operationsor events and what types of data are to be reported to those entities.The agency engine 624 can then collect the pertinent data, potentiallyformat and/or analyze the data, and facilitate transmission of (e.g.,raw, formatted and/or analysis of) the data to the appropriate agency.

FIG. 7 shows a diagram 700 which depicts a portion of the medicalarchitecture stack 300 according to an embodiment of the invention. Inparticular, the diagram 700 includes the interface layer 316, and theapplication/device layer 320. Within the interface layer 316 is locatedinterface engine 702 (e.g., the interface engine 224). The interfaceengine 702 is configured to generate one or more interfaces (e.g.,graphical user interface 726, programmatic interface 728, and/or webinterface 730) to enable medical-related data to flow to user devices710, 712, and 714 via respective applications 720, 722, and 724. In someexamples, the interfaces of the interface engine 702 are embodied inhardware, software, or some combination of both. Within the interfacelayer 316 communications and inputs directed to interacting withelements of the access management layer 310 may be embodied.

The graphical user interface 726 is any suitable graphical userinterface configured to interact with elements of the medical providernetwork. The programmatic interface 728 includes an applicationprogramming interface, a programmatic user interface, and other similarinterfaces for defining core functions for accessing elements of themedical provider network. For example, the programmatic interface 728may specify software components in terms of their operations. The webinterface 730 is any suitable web interface configured to interact withelements of the medical provider network. Any of the interfacesdescribed herein may be configured to receive user input, presentdynamic presentations that depend on user input, and otherwise respondto user input. In some examples, such input may be provided via one ormore input devices (e.g., a keyboard, touchscreen, joystick, mouse,microphone, medical devices capable of capturing inputs, and the like)operated by one or more users of the user devices 706-714. Output may beprovided via one or more output devices (e.g., a display or speaker).

The interface engine 702 is utilized by applications internal to themedical provider network and external to the medical provider network toaccess medical-related data. In some examples, the applications that areinternal include applications that are developed for internal use byemployees, patients, nurses, medical care professionals, medical careproviders, contractors, and others associated with the medical providernetwork. In some examples, the applications that are external to themedical provider network include applications that are developed forexternal use by those that are not associated with the medical providernetwork.

Generally, within the application/device layer 320, the applications716-724 which communicate with other elements of the medicalarchitecture stack 300 using the interfaces generated by the interfaceengine 702 are defined. This includes detailing how the applications716-724 are to interact with the interfaces generated by the interfaceengine 702 for accessing medical-related data. For example, interactingmay include accepting inputs at the user devices 706-714 to accessmedical-related data and, in response, providing the data, prompts, orother types of interaction with one or more users of the user devices716-714. Thus the applications 716-724 may be related to one or more ofthe interfaces generated by the interface engine 702. For example, theapplication 720 may be interact with a graphical user interface (whethergenerated by the interface engine 702 or otherwise) to interact withother elements of the medical provider network. Interacting may includereceiving inputs at the graphical user interface via the application720, providing output data (e.g., medical-related data includingreports, data sets, patient record information, diagnosis information,treatment care information, and the like) to the graphical userinterface via the application 720, enabling interaction with other userdevices, other applications, and other elements of the medical providernetwork, and the like. For example, some of the inputs may pertain toaggregation of medical-related data. These inputs may include, forexample, types of data to aggregate, aggregation parameters, filters ofinterested data, keywords of interested data, selections of particulardata, inputs relating to presentation of the data on the graphical userinterface, and the like. Providing output data may include providing theaggregated data on the graphical user interface, outputting theinformation to one of the other user devices 706-714 running one of theother applications 716-724.

Turning now to the details of the applications 720, 722, and 724. Insome examples, the applications 720, 722, and 724 include a variety ofdifferent applications that can be designed for particular users and/oruses. In one example, the application 720 is specific for doctors. Inthis example, the application 720 includes dashboards, widgets, windows,icons, and the like that are customized to the individual doctor. Insome examples, the application 720 may present different medical-relateddata depending on a specialty associated with the doctor and protectedhealth information associated with the doctor's patient. In this manner,the application 720 adapts and automatically adjusts depending on thecontext in which the doctor is using the application. In some examples,the medical-related data indicates performance statistics for thedoctor, metrics relating to where the doctor falls along a distributionof other similar doctors, outlier patients, trends in diagnosis numbersand release, rapid changes in health-related values for the doctor'spatients compared to other similar patients, and the like. Theapplication 720 may be configured to receive input, adjustpresentations, present unprompted alerts, adjust display of content,move more relevant content to the foreground, move less relevant contentto the background, populate forms for the doctor to order tests, and thelike.

In another example, the application 722 may be specific for nurses ortypes of nurses. In this example, the application 722 may includedashboards, widgets, windows, icons, and the like that are customized toindividual nurses. Similar to the example discussed above pertaining tothe doctor, in some examples, the application 724 may present differentmedical-related data depending on a position of the nurse. In thismanner, the application 722 adapts and automatically adjusts dependingon the context in which the nurse is using the application. For example,the nurse may receive medical-related data, such as test results for apatient. In some examples, the application 722 (or any otherapplication) may be configured to operate on a mobile device.

In some examples, the application 724 may be a multi-role applicationfor administrators and is used to manage patients and others thatconstitute the population of the entities or organizations within themedical provider network. Similar to the other examples discussed, insome examples, the application 724 may present different medical-relateddata depending on a role of the user who is using the application 724.In this manner, the application 724 adapts and automatically adjustsdepending on characteristics of the user who is using the application724. In this manner, the application 724 provide differentmedical-related data depending on the role of the user. For example, toan administrator may be presented identifying or de-identifiedinformation that characterizes overall flow of patients within ahospital (e.g., intake date, insurance, bed location, expected checkoutdate, etc.).

In some examples, the application 724 may be a business intelligenceapplication. In this example, the application 724 is used to displaybusiness information generated by components of the medical providernetwork. This business information can be used for operations, planning,and forecasting. Such business information may include medical-relateddata because such data may impact operations, planning, forecasting, andthe like. Accordingly, the application 724 may present de-identifiedinformation in the form of one or more metrics, indicators, or the likeas they pertain to business intelligence.

The applications 716 and 718 shown in connection with the interfaceengine 702 are applications developed by third-parties. In someexamples, such applications include any suitable application thatbenefits from accessing medical-related data. For example, theapplication 716 may be a health application, a nutrition application, afitness application, and other similar applications. The medicalprovider network may include medical-related data pertaining to hundredsof thousands of patients. Having data pertaining to so many patientspresents security concerns. For example, much of the medical-relateddata may be identifying data. Certain disclosure laws may prohibit thedisclosure of such information. Accordingly, data that may be accessedby the applications 716 and 718 may be limited. In some examples, apatient of the medical provider network may use one of the applications716, 718 to access his or her own medical-related data. In this example,the identity of the patient may be verified in accordance withtechniques described herein.

The user devices 706-714 are any suitable user devices capable ofrunning the applications 716-724. The user devices 706-714 are examplesof the user device 228. In some examples, the user devices include:mobile phones, tablet computers, laptop computers, wearable mobiledevices, desktop computers, pagers, and other similar user devices. Insome examples, at least some of the user devices 706-714 are the samedevices as at least some of the one or more components 410-418. In someexamples, the user devices 706-714 may include complementary layers tothe application/device layer 320 and/or the receiving layer 302. Forexample, the user devices 706-714 may include a transmission layer, ageneration layer, and/or a receiving layer to communicate data at theapplication/device layer 320 and at the receiving layer 302.

Turning now to FIG. 8 , a medical provider network 800 is shown inaccordance with an embodiment of the invention. The medical providernetwork 800 includes an internal organization 822 including atransformative integration engine 802. The transformative integrationengine 802 is an example of the transformative integration engine 202previously discussed. The medical provider network 800 is illustrated asan example configuration for implementing the techniques describedherein. In particular, a configuration of elements as illustrated inFIG. 8 , at least in some examples, communicates according to the layersof the medical architecture stack 300. For example, the internalorganization 822 includes generation components 804(1), 804(2), and804(N) which provide medical-related data to aggregation servers806(1)-806(N).

The generation components 804(1), 804(2), and 804(N) operate inaccordance with the receiving layer 302. In some examples, thegeneration component 804(1) is an Mill machine, a type of medicalequipment, the generation component 804(2) is computer with a datacollection device, a type of lab system, and the generation component804(N) is a terminal, which is a type of business component or clinicalcomponent. The aggregation servers 806(1)-806(N) operate in accordancewith the aggregation layer 304. The aggregation servers 806(1)-806(N)share medical-related data with data storage servers 808(1)-808(N) viaone or more internal network(s) 810. In some examples, the internalnetwork 810 is any suitable network capable of handling transmission ofmedical-related data. For example, the internal network 810 may be anysuitable combination of wired or wireless networks. In some examples,the internal network 810 may include one or more secure networks. Thedata storage servers 808(1)-808(N) are configured to storemedical-related data in accordance with the active unified data layer308. The data storage servers 808(1)-808(N) include database servers,file storage servers, and other similar data storage servers.

Access management servers 812(1)-812(N) manage access to themedical-related data retained in the data storage servers 808(1)-808(N).The access management servers 812(1)-812(N) communicate with the otherelements of the medical provider network 800 via the internal network810 and in accordance with the access management layer 310.

Interface servers 814(1)-814(N) provide one or more interfacesapplications to interact with the other elements of the medical providernetwork 800. The interface servers 814(1)-814(N) provide the one or moreinterfaces and communicate with the other elements of the medicalprovider network 800 via the internal network 810 and in accordance withthe interface layer 316. The interfaces generated by the interfaceservers 814(1)-814(N) can be used by internal user devices 816(1)-816(N)and external user devices 818(1), 818(2), and 818(N) to interact withelements of the medical provider network 800.

The internal user devices 816(1)-816(N) are examples of the user devices706-714. In some examples, the internal user devices 816(1)-816(N) runapplications for patients, doctors, specialists, nurses, administrativeprofessionals, network administrators, business leaders, and others thataccess the other elements of the medical provider network 800 via theinterfaces generated by the interface servers 814(1)-814(N). As anadditional example, the external user devices 818(1), 818(2), and 818(N)run applications developed by third parties for patients, doctors,specialists, nurses, administrative professionals, networkadministrators, business leaders, and others that access the otherelements of the medical provider network 800 via the interfacesgenerated by the interface servers 814(1)-814(N).

The external user devices 818(1), 818(2), and 818(N) access theinterfaces via external network 820. In some examples, the externalnetwork 820 is an unsecured network such as the Internet. The externaluser devices 818(1), 818(2), and 818(N) are examples of the user devices706-714. The external user device 818(1) is a mobile device. In someexamples, the mobile device may be configured to run an application toaccess the medical provider network 800. Similarly, the other externaluser devices 818(2)-818(N) run applications that enable them to accessthe medical provider network 800. While the medical provider network 800is shown as implemented using discrete servers, it is understood that itmay be implemented using virtual computing resources and/or in aweb-based environment.

Embodiments herein are directed to a notification service. Inparticular, to a notification service that enables a user that isassociated with a patient to sign up to receive notifications regardingtreatment of the patient. For example, the notifications may indicatethat an admitted patient has moved from a first room in a hospital to asecond room in the hospital. To protect the privacy of the patient, auser that desires to receive notifications is subjected to anauthorization process. During the authorization process, the identity ofthe user and/or an identify of the patient may be verified. For example,the requesting user may be required to provide personal informationabout the patient to the notification service. The notification servicemay then verify this personal information against comparable informationon file for the patient. Once verified, the user can receive updatesregarding the treatment of the patient. To determine when updates shouldbe sent, the notification service monitors for certain events that wouldtrigger notification. These events may be identified as one or morecomponents of a messaging system monitor medical messages that flow overa messaging hub. Once a message is identified that is related to thepatient, the notification service may determine whether report out aportion of the message, based at least in part on the substance of themessage. In some examples, the notification service maintains a set ofnotification rules that define the circumstances under which a messagemay be provided in the form of a notification. To this end, thenotification rules may be pre-defined, user-defined, learned, generated,or otherwise populated. In some examples, the notification rules may bespecific to a particular patient (e.g., a first patient may authorizemore information to be shared compared to a second patient) or to aparticular group of patients (e.g., patients that are children may haveparticular rules specific for all children), and may also be generic forall users. For example, certain types of personal health information maynever be reported out as a notification. In some examples, thenotifications are sent via text message to a user device of the user.

Turning now to FIG. 9 , a block diagram of a messaging system 900 of amedical provider network is shown in accordance with an embodiment ofthe invention. The messaging system 900 may be implemented using atleast some of the elements of the medical provider network 800. Themessaging system 900 includes a notification service 902 (e.g., thenotification service 238), which is configured to implement thetechniques described herein. The messaging system 900 includes thenotification service 902 in network communication with a messaging bus904 (e.g., the messaging bus 430). The notification service 902 isconfigured to implement the techniques described herein. For example,the notification service 902 may enable generation of notificationsrelating to the treatment of patients within a medical provider network.

The messaging bus 904 is any suitable combination of hardware and/orsoftware configured to implement communication between differentelements and applications of a network. For example, the messagingsystem 900 includes a number of elements in network communication withthe messaging bus 904. In some examples, elements also includeapplications and/or the devices on which the applications are running.The elements include, for example, components 906 (e.g., the components412), a transformative integration engine 908 (e.g., the transformativeintegration engine 102), other entities 912, and the notificationservice 902 in communication with the messaging bus 904 via buslisteners 914 and/or directly. Users 918 may utilize the components 906and/or one or more applications running on the components 906 togenerate medical messages. The users 918 are examples the medicalprofessionals and other users who access the components 906 to generatemedical messages as described herein. In some examples, certain ones ofthe components 906 generate medical messages without any one of theusers 918.

In this manner, the messaging bus 904 allows the elements of themessaging system 900 to be easily plugged in and out (switched on andoff) of the medical provider network (e.g., the medical provider network800) without impact on other elements and without the need to restartthe messaging system 900 or even stop running applications on theelements (e.g., the components 906). In some examples, the messaging bus904 may function as a single message turntable between the elements ofthe messaging system 900. In effect, such functioning reduces the numberof point-to-point connections between communicating elements of themessaging system 900. Thus, each element of the messaging system 900directs its messages through the messaging bus 904 instead of goingdirectly to the end point (e.g., a server, storage device, or otherelement). This indirection allows the messaging bus 904 to monitor andlog the traffic. In this manner, the messaging bus 904 can intervene inmessage exchange.

The messaging bus 904 supports publish/subscribe functionality. In thismanner, other elements of the messaging system 900 and other elements(not shown) may be provided with indications when certain messageshaving certain characteristics are passed over the messaging bus. Forexample, the bus listeners 914 are examples of elements that takeadvantage of the publish/subscribe functionality. The bus listeners 914are examples of subscribers. The components 906, the transformativeintegration engine 908, and the other entities 912 are examples ofpublishers. However, in some examples, the components 906, thetransformative integration engine 908, and/or the other entities 912 mayhave subscriber characteristics as well. For example, the other entities912 may have their own bus listeners configured to listen for certainmessages and provide the other entities 912 with the messages onceidentified. In any event, the bus listeners 914 may be configured tolisten for specific messages. Once a particular message, for which oneof the bus listeners 914 has been initiated, is put on the messaging bus904 (e.g., “published”), the bus listener 914 can identify and retrievethe message from the messaging bus 904. Thus, the bus listener 914 canretrieve the message, even if the expected recipient of the message isunknown to the bus listener 914.

In some examples, a single bus listener 914 is initiated that for eachpatient whose records will be monitored by the notification service 902.For example, once a patient authorizes the notification service 902 tomonitor his or her records, a bus listener 914 may be initiated and/orgenerated which listens for messages which include characteristics ofthe patient. Example characteristics include identifying andde-identified forms of personal health information (PHI). Once the buslistener 914 identifies a message which includes such characteristics,it makes it available to the notification service 916 for furtherprocessing. In some examples, the components 906 provide information tothe messaging bus 904 directly or via some other device.

In some examples, the notification service 916 initiates a bus listener914 to listen to the messaging bus 904 (i.e., to scan information goingon to and off of the messaging bus 904) for a particular type ofinformation (e.g., discharge information), information for a particularuser (e.g., a patient), or the like. Once the bus listener 914identifies the requested information, if authorized, the bus listener914 can remove the information and provide it to the notificationservice 916. The notification service 916 can then processes theinformation. In some examples, once the bus listener 914 identifies therequested information, the bus listener 914 requests the providingelement to provide the information to the notification service 916(e.g., in a point-to-point fashion).

In some examples, the bus listeners 914 include one or more informationbarriers to ensure that PHI is not inappropriately shared with the otherentities 912 or other elements of the messaging system 900. The one ormore information barriers can include logical separations and/orphysical separations. And while the messaging system 900 can includesenterprise level network security which is often reliable, certainelements of the messaging system 900 may not be subject to as muchsecurity scrutiny. As such, in some examples, the bus listener 914 isenabled to only read de-identified information.

In some examples, the other entities 912 and the users 918 (via thecomponents 906) are in network communication with the messaging bus 904.The other entities 912 and/or the users 918 may be associated with amedical care organization which provides care to the patient. In someexamples, each of the users 918 and/or the other entities 912 mayprovide and/or receive medical-related information in the form ofmedical messages. For instance, in some examples, each connection to themessaging bus 904 is an individual domain such that the other entities912 and the components 906 communicate with the messaging bus 904 viadifferent formats, proprietary protocols, varying encryption techniques,various languages, different machine languages, and the like. In someexamples, the connections are dedicated and/or shared VPN tunnels. Insome examples, the bus listeners 914 are configured to identify medicalmessages from the different other entities 912 and the components 906.

The other entities 912 may be, for example, an urgent care facility, anoutpatient facility, a hospital, a clinic, a record service, or anyother suitable entity which provides or receives medical-related data.In particular, the record service may include one or more serversconfigured to retain medical record for patients. In some examples, themedical records are updated at one of the other entities (e.g., ahospital) and provided to the record service via the messaging bus 904.In this manner, the bus listeners 914 can identify the movement ofmedical-related data in the form of medical messages relating to medicalrecords of patients. In some examples, medical-related data from theother entities 912 (e.g., the record service) may flow toward thetransformative integration engine 908 as described herein. In someexamples, the components 906 and/or the users 918 may be located at oneor more of the other entities 912. In this manner, the components 906may generate medical-related data at the other entities 912.

In some examples, the notification service 902 is configured to maintainanalytics relating to the process flow of patients through theindividual systems of the other entities 912. For example, a hospital(an example of one of the other entities 912) is configured to track theprogress of patient X as patient X moves through different stages ofreceiving medical services at the hospital. The hospital also providesthis tracking information to the messaging bus 904, which is picked upby a previously-initiated bus listener 914 and, in turn, accessed by thenotification service 916. The notification service 916 may then generatenotifications, alarms, statuses, updates, reminders and the like tomedical care professionals of the hospital or authenticated usersrelating to patient X's care.

An example flow of patient X's treatment begins as he or she isregistered at the hospital. In connection with his or her admittance,the hospital enters into its system the record information relating tohis or her admittance (e.g., referral, intake paperwork, nurse reports,doctor reports, etc.) and a patient flow for patient X is created. Inthis example, the patient flow identifies the anticipated milestones,events, and other indicia related to treatment of patient X at thehospital. The patient flow information is shared with the notificationservice 902 via the messaging bus 904. In some examples, thenotification service 902 is requested to create patient flows for newpatients of the hospital. With the patient flow information, thenotification service 902 can initiate the bus listeners 914 to monitorand track the progress of patient X as he or she progress through his orher treatment at the hospital. In one example, after an x-ray is orderedfor patient X, the notification service 902 learns of this order, andgenerally informs the hospital and/or directly informs medical careprofessionals associated with the hospital that the x-ray has beenordered and an estimated time for completion. If the x-ray is taking toolong (e.g., patient X has been waiting longer than a pre-determinedthreshold), the notification service 902 notifies the hospital. In thismanner, the notification service 902 monitors and manages process flowsfor patients of the hospital. In other embodiments, the notificationservice 902 monitors the flows for other patients of the other entities912 of the messaging system 900.

In addition to monitoring the flow of patients and notifying the otherentities 912 and/or the users 918, the notification service 902 providesnotifications to the users 918 via the components 906 relating to theprogress, status, and the like of patients associated with the medicalrecord information. For example, the users 918 may be first respondersand the components 906 may be radios. Once a first responders isverified by the notification service 902, the first responder may beenabled to receive medical-related data regarding a victim who the firstresponder is treating in the field.

Turning next to FIG. 10 , a block diagram illustrating a messagingsystem 1000 according to at least one example. The messaging system 1000is an example of the messaging system 900 which illustrates otheraspects in greater details. For example, the messaging system 1000includes a notification service 1002 (e.g., the notification service916) connected to bus listeners 1004 (e.g., the bus listeners 914) viaan internal network 1006. The internal network 1006 is an example of anetwork that has restricted access. For example, when the techniquesdescribed herein are implemented at a single hospital, the internalnetwork 1006 may be local area network within the hospital. When thetechniques described herein are implemented in a medical careorganization that includes many facilities, the internal network 1006may be a network with enterprise level security appropriate for passingmedical-related information.

As described herein, the bus listeners 1004 are in network communicationwith the messaging bus 904 (as indicated by circle 1008). In someexamples, the messaging bus 904 is also in network communication withthe internal network 1006.

The messaging system 1000 also includes users 1010 and user device1012(1)-1012(N) (the user device(s) 1012). In some examples, the userdevices 1012 are in network communication with the notification service1002 via the internal network 1006. The user device 1012 may be anysuitable device capable of communicating with the notification service1002 and/or the message vendor 1016. For example, the user device 1012may be any suitable computing device such as, but not limited to, amobile phone, a smart phone, a personal digital assistant (PDA), alaptop computer, a personal computer, a desktop computer, a set-top box,a thin-client device, or other computing device. In some examples, theuser device 1012 may be a cellular telephone. The user device 1012 mayinclude a memory, a processor, a web-service application, a messagingapplication, and any other suitable feature to enable communication andinteraction with the elements of the messaging system 1000.

For example, when the user 1010 is a medical care professional, perhapsas an employee of the medical care organization that hosts thenotification service 1002, the medical care professional may beauthorized to receive notifications regarding the treatment a patient ofthe medical care professional's via the internal network 1006. Becausethe internal network 1006 includes added layers of security compared toexternal network 1014, the notifications provided via the internalnetwork 1006 may, in some examples, be more detailed compared tonotifications provided via the external network 1014. For example,notifications provided via the internal network 1006 may includepersonal health information, while notifications provided via theexternal network 1014 may be stripped of any personal healthinformation. In this manner, notifications may be provided to differentones of the users 1010 via different ones of the networks 1006, 1014.

The external network 1014 and/or the internal network 1006 may be anysuitable network including, for example, any suitable combination ofcable, cellular, radio, digital subscriber line, or any other suitablenetwork, which may be wired and/or wireless.

In some examples, the messaging system 1000 also includes a messagevendor 1016. In some examples, the message vendor 1016 is configured toprovide notifications to the users 1010 via the user devices 1012. Forexample, the message vendor 1016 may a third-party which receivesrequests from the notification service 1002 and generates notificationsthat can be received by the users devices 1012. For example, the messagevendor 1016 may provide notifications to the user device 1012 byaccessing an address of the user device 1012 and generating anotification using one or more message services. The notification may besent by the message vendor 1016 using a short message service (SMS), amultimedia message service (MMS), an instant messaging service, or anyother suitable messaging service. In some examples, the message vendor1016 receives the address of the user device 1012 from the notificationservice 1002 along with the notification. In some examples, the messagevendor 1016 performs one or more operations on the notification prior tosending it out. For example, the message vendor 1016 may shorten thenotification to comply with character restrictions. In some examples,the message vendor 1016 may send more than one notification based on asingle notification received from the notification service 1002. In someexamples, the message vendor 1016 has a virtual private network tunnelwith the internal network 1006. In some examples, the message vendor1016 is configured to encrypt messages prior to sending them to the userdevices 1012. In this manner, the messages may carry more sensitivenotifications (e.g., forms of personal health information) to the userdevices 1012. In this example, the user devices 1012 may beappropriately configured to decrypt the messages received from themessage vendor 1016.

In some examples, the message vendor 1016 is not included in themessaging system 1000. In this example, the notification service 1002transmits messages directly to the user devices 1012 via the internalnetwork 1006, the external network 1014, and/or any combination of theforegoing.

Generally, the notification service 1002 may be configured forimplementing techniques relating to providing notifications as describedherein. The notification service 1002 may include one or more computers,perhaps arranged in a cluster of servers or as a server farm, and mayperform the computing techniques described herein. The notificationservice 1002 may therefore include at least one memory 1018 and one ormore processing units (or processor(s)) 1020. The processor(s) 1020 maybe implemented as appropriate in hardware, computer-executableinstructions, software, firmware, or combinations thereof.Computer-executable instruction, software or firmware implementations ofthe processor(s) 1020 may include computer-executable ormachine-executable instructions written in any suitable programminglanguage to perform the various functions described. The memory 1018 mayinclude more than one memory and may be distributed throughout thenotification service 1002. The memory 1018 may store programinstructions (e.g., the notification module 1022) that are loadable andexecutable on the processor(s) 1020, as well as data generated duringthe execution of these programs. Depending on the configuration and typeof memory including the notification service 1002, the memory 1018 maybe volatile (such as random access memory (RAM)) and/or non-volatile(such as read-only memory (ROM), flash memory, or other memory). Thenotification service 1002 may also include additional removable storageand/or non-removable storage including, but not limited to, magneticstorage, optical disks, and/or tape storage. The disk drives and theirassociated computer-readable media may provide non-volatile storage ofcomputer-readable instructions, data structures, program modules, andother data for the computing devices. In some examples, the memory 1018may include multiple different types of memory, such as static randomaccess memory (SRAM), dynamic random access memory (DRAM), or ROM.Turning now to the contents of the memory 1018 in more detail, thememory 1018 may include an operating system 1024 and one or moreapplication programs, modules, or services for implementing the featuresdisclosed herein including at least the notification module 1022 and itsassociated components.

In some examples, the notification service 1002 may also includeadditional storage 1026, which may include removable storage and/ornon-removable storage. The additional storage 1026 may include, but isnot limited to, magnetic storage, optical disks, and/or tape storage.The disk drives and their associated computer-readable media may providenon-volatile storage of computer-readable instructions, data structures,program modules, and other data for the computing devices. The memory1018 and the additional storage 1026, both removable and non-removable,are examples of computer-readable storage media. For example,computer-readable storage media may include volatile or non-volatile,removable, or non-removable media implemented in any suitable method ortechnology for storage of information such as computer-readableinstructions, data structures, program modules, or other data. As usedherein, modules may refer to programming modules executed by computingsystems (e.g., processors) that are part of the notification module1022. The notification service 1002 may also include input/output (I/O)device(s) and/or ports 1028, such as for enabling connection with akeyboard, a mouse, a pen, a voice input device, a touch input device, adisplay, speakers, a printer, or other I/O device.

In some examples, the notification service 1002 may also include a userinterface 1030. The user interface 1030 may be utilized by an operator,or other authorized user to access portions of the notification service1002. In some examples, the user interface 1030 may include a graphicaluser interface, web-based applications, programmatic interfaces such asapplication programming interfaces (APIs), or other user interfaceconfigurations. The notification service 1002 may also include datastore 1032. In some examples, the data store 1032 may include one ormore databases, data structures, or the like for storing and/orretaining information associated with the notification service 1002. Thedata store 1032 may include data structures, such as user informationdatabase 1034 and look-up database 1036. While the data store 1032 isshown including only two databases (i.e., the user information database1034 and the look-up database 1036), as would be recognized by one ofordinary skill in the art, the data store 1032 may include any suitablenumber of databases, including fewer than two or more than two.

The user information database 1034 may be used to store informationabout the users 1010 such as, for example, demographic information,medical information, record information, user preferences (e.g.,language), contact information (e.g., a phone number), messaginginformation (e.g., length and frequency of notifications desired, typesof notifications desired, etc.), and the like. Such users, include, forexample patients, family members, medical care professionals, firstresponders, and the like. For example, within the user informationdatabase 1034 may be retained information describing those users whichhave signed up to receive notifications (e.g., authorized users) anduser who have authorized notifications to be sent on their behalf (e.g.,patients). In some examples, the look-up database 1036 includesinformation capable of identifying users based on de-identifiedinformation. For example, the look-up database 1036 can include a firstcolumn with the unique patient IDs and a second column matching the IDsto other patient identifying information and/or instructions fornotifying other users such as recipients.

The notification module 1022 may be configured to manage one or moresub-modules, components, engines and/or services directed to examplesdisclosed herein. In some examples, the notification module 1022 mayinclude an initiation engine 1044, an authentication engine 1046, anlistening engine 1038, a modification engine 1040, and a routing engine1042. While these engines are illustrated in FIG. 10 and will bedescribed as performing discrete tasks with reference to the flowcharts, it is understood that FIG. 10 illustrates example configurationsand other configurations performing other tasks and/or similar tasks asthose described herein may be implemented according to the techniquesdescribed herein. Other engines, whether embodied in software orhardware, may perform the same tasks as the notification module 1022 orother tasks and may be implemented in a similar fashion or according toother configurations.

The initiation engine 1044 is configured to handle initialcommunications with a patient who desires to receive notifications ordesires to have others receive notifications or her behalf. To this end,the initiation engine 1044 is configured to receive a notificationrequest from a user device of the patient. In the notification request,the patient may identify that she desires that notifications pertainingto her treatment be sent. These notifications may specify one or moredecisions made regarding the patient and/or actions performed inrelation to responding to the current conditions of the patient. Thecurrent conditions may relate to the current conditions of the health ofthe patient.

The authentication engine 1046 is configured to authorize users whichare to receive notifications on behalf of the patient. To this end, theauthentication engine 1046 is configured to receive authorizationrequests from user devices of second users. A particular authorizationrequest may include identifying information of the patient and may beprovided by a requesting user. Using this identifying information, theauthentication engine 1046 verifies that the requesting user isauthorized to receive the notifications. This may include comparing theidentifying information in the authorization request with patient recordinformation of the patient. In some examples, the requesting user isonly authorized to receive a portion of the notifications. In thismanner, the distribution of notifications may be limited to those users(and respective user devices) that are authorized by the patient and thenotification service 1002.

The listening engine 1038 is configured to identify a particular patientbased at least in part on a message or portion of a message provided bythe bus listener 1004 or on information provided directly from one ofthe user devices 1012. To this end, the listening engine 1038 isconfigured to initiate the bus listeners 1004. The bus listeners 1004operate as described herein to identify messages which identify thepatient and/or a user device associated with the patient. In oneexample, the bus listener 1004 receives instructions to monitorde-identified information for a unique patient ID. Once the bus listener1004 identifies a message corresponding to the unique patient ID, thebus listener 1004 transfers at least a portion of the message to thenotification module 1022, where the listening engine 1038 performs oneor more operations on the message to identify it (i.e., determine towhich patient it belongs). In one example, the listening engine 1038 maymake one or more queries to the look-up database 1036 to assist inidentifying the message. The queries may request informationcorresponding to the message received from the bus listener 1004. Thelistening engine 1038 may receive in return adequate information tomatch the message to a particular patient. From this information, othercomponents of the notification module 1022 may generate a notification.

The modification engine 1040 may be configured to perform one or moreoperations on the message received from the bus listener 1004. To thisend, the modification engine 1040 may include one or more rule sets todetermine how perform its operations to modify the message. For example,rules may be particularized to users, groups of users, and the like. Insome examples, a rule may indicate that all identifying information beremoved from a message before a notification is generated. Another rulemay indicate whether the message should be translated from one languageto another language prior to being provided to the device 1012. Thus,the rules may reference user information, including user settings,retained in the user information database 1034. Any of the modificationrules may be user-defined, machine-defined, learned, generated, orotherwise created. In some examples, the rules may ensure compliancewith regulations which limit the amount of health information that maybe exchanged using unsecured communication channels. In some examples,the modification engine 1040, in accordance with the rules or otherwise,performs a language translation (e.g., from Russian to English),performs a format translation (e.g., from a first proprietary format toa vanilla or homogenized format), performs a machine languagetranslation (e.g., from a first machine language to a second machinelanguage), performs a conversion (e.g., from one unit system to a secondunit system), performs a mathematic function (e.g., rounds numericinformation to a certain number of significant digits), and the like. Insome examples, such modification may be helpful to providing accuratenotifications to the user devices 1012.

The routing engine 1042 may be configured to generate notifications inaccordance with the techniques described herein. In some examples, therouting engine 1042 generates notifications in accordance with one ormore notification rules. The notification rules may indicatecharacteristics of the notifications that will be sent to the userdevices 1012. For example, the notification rules may indicate thenumber of characters supported by a particular user device 1012. In someexamples, the notification rules include generic rules and specificrules. Any of the notification rules may be user-defined,machine-defined, learned, generated, or otherwise created. Once anotification is generated, the routing engine 1042 transmits thenotification to the authorized user device (e.g., the user device 1012).In some examples, the routing engine 1042 transmits the notification tothe message vendor 1016 and the message vendor provides the notificationto the user device 1012.

Turning now to FIG. 11 , in which is illustrated process 1100illustrating an example flow diagram depicting techniques relating toproviding notifications to user devices in accordance with at least oneexample. The illustrated flow diagram includes areas identified by theuser device 1012, one or more bus listeners 1004, the notificationservice 1002, and the message vendor 1016. While certain acts will bediscussed within each of the respective areas, it is understood that thesame acts may take place in different areas or by different entities.

The process 1100 begins at 1102 where the user device 1012 providesauthentication information to the notification service 1002. When theuser of the user device 1012 is a patient, the authenticationinformation may capable of identifying the user. When the user of theuser device 1012 is a person other than the patient (e.g., a familymember, friend, medical professional, or other person desiring toreceive notifications regarding the patient), the authorizationinformation may be capable of identifying the user. For example, theauthentication information may include identifying information of thepatient. Such information may have been previously provided to the userof the user device 1012 prior to the user providing the authenticationinformation at 1102. For example, the patient may sign up with thenotification service 1002 by sending a notification request to thenotification service 1002 (not shown). The notification service 1002 mayindicate in one of the data stores (e.g., the data store 1032) that thepatient desires to receive notifications and/or desires that othersreceive notifications.

At 1104, the authentication information 1104 is received by thenotification service 1002. At 1106, the notification service 1002verifies the authentication information. In some examples, verifying theauthentication information may include comparing the authenticationinformation (e.g., a unique patient ID, a portion of a unique patientID, a date of birth of the patient 118, and/or any other types ofinformation described herein) with similar types of information in thedata store 1032 to verify that the information provided by the patientor non-patient user matches the information on record for the patient.This may include the notification service 1002 comparing theauthentication information (e.g., a date of birth of the patient andunique patient ID of the patient) received with lists of dates of birthand lists of unique patient IDs stored in the data store 1032. Uponverification of the authentication information at 1106, a portion of theverified information is provided to the message vendor 1016 in the formof user access information at 1108. The user access informationindicates suitable information such that the message vendor 1016 cancontact the user on the user device 1012. Thus, in some examples, theuser access information may include a phone number, email address, orother form of contact information of the user such that the messagevendor 1016 can later send notifications to the user.

In some examples, at 1108, process 1100 receives user accessinformation. In some examples, the user access information is receivedby the message vendor 1016 independent of the verification at 1106. Forexample, the notification service 1002 may compile a list of phonenumbers for user who have requested notifications. The notificationservice 1002 may provide this list of phone numbers to the messagevendor 1016 at any time prior to when the message vendor 1016 sends outa notification to one of the users. In some examples, the user accessinformation is provided to the message vendor 1016 in connection with anotification that is to be sent to the user device 1012 (e.g., at 1120).

At 1110, the process 1100 initiates listeners. In some examples, thenotification service 1002 initiates the listeners at 1110. As describedherein, the listeners may be embodied hardware, software, or anycombination of hardware and software. The listeners may be configured tomonitor messages that flow over a messaging bus and retrieve certainmessages that they are listening for. In some examples, the listenersmay be configured to provide messages or a portion of messages from themessaging bus. The messages may be generated for any number of reasons.For example, the messages may be generated in response to one moreevents including, for example, an adjustment to a medical record of thepatient, an adjustment to a location of the patient in a medical carefacility, an order of a medical test for the patient, an order of aprescription for the patient, a commencement of a medical procedure onthe patient, a conclusion of a medical procedure on the patient, achange in a condition of the patient, or any other event. In someexamples, the one or more events include an update to a medical recordof the patient. In some examples, a medical care professional may haveentered a note into the medical record of the patient pertaining to thetreatment of the patient. The entry of this note (e.g., a change in themedical record) may prompt a message to flow over the messaging hub. At1112, one of the bus listeners 1004 may identify the message.Identifying the message may include the bus listeners 1004 identifyingthat a particular message includes information identifying the patient.

At 1114, the process 1100 determines whether the identified message isthe type of message that should be reported out to the user. In someexamples, the message service 1002 makes this determination. The buslisteners 1004 may identify many messages which identify the patient,only some of which may be relevant to the user or even reportable to theuser. For example, a message that indicates lab results for the patientmay not be reportable because it is prohibited by law. In some examples,the determination at 1114 is performed in accordance with one or morerules. At least some of the rules may be generic to all patients and atleast some rules may be specific to particular users. In some example,the message may be irrelevant to the user and may therefore not beincluded in a notification.

If the determination at 1114 is NO, the process 1100 returns to 1112where the bus listeners 1004 identify messages. If the determination at1114 is YES, the process 1100 continues to 1116 where the message ismodified. As described herein, the message may be translated, shortened,altered, or otherwise adjusted at 1116. In some examples, even if amessage is within the scope at 1114, the message may still be modifiedat 1116. In some examples, this may be desirable such that thenotifications that are provided are consistent and comply with userpreferences. In some examples, the message may include medical-relatedinformation such as, for example, personal health information (PHI)(i.e., any information about health status, provision of health care, orpayment that can be linked to the patient) and also includes any of thefollowing information capable of identifying the patient: names,geographic identifiers, dates directly relating to the patient 118,phone numbers, fax numbers, email addresses, social security numbers,medical record numbers, health insurance beneficiary numbers, accountnumbers, certificate/license numbers, vehicle identifiers and serialnumbers, device identifiers and serial numbers, web Uniform ResourceLocators, Internet Protocol addresses, biometric identifiers (e.g.,finger, retinal, and voice prints), full face photographic images andany comparable images, and any other unique identifying number,characteristic, or code.

At 1118, the process generates a notification. In some examples, thenotification service 1002 generates the notification. In some examples,the notification is generated in accordance with one or more generationrules. The rules may indicate formats for notifications including, forexample, character limits, supported formats and characters, languages,etc. For example, in some cases, translation of the message occurs whenthe notification is generated at 1118 and not at 1116 when the messageis modified. In some examples, personal health information is removedfrom the message as the notification is generated. In this manner, thenotification is devoid of personal health information.

At 1120, the process provides the notification. In some examples, thenotification service 1002 provides the notification. Providing thenotification may include the notification service transferring thenotification to the message vendor 1016. In some examples, the messagevendor 1016 and the notification service 1002 are connected via avirtual private network. In any event at 1122, the process 1100 receivesthe notification. In some examples, the message vendor 1016 receives thenotification. The notification may include information about thepatient. For example, the notification may indicate a status of thepatient's treatment and many other like notifications as describedherein.

At 1124, the process 1100 identifies user access information. In someexamples, the message vendor 1016 identifies the user accessinformation. In some examples, the user access information has beenprovided prior to the notification being received at 1122. In someexamples, the notification at 1122 includes the user access information.In this example, the message vendor may only be given a minimum amountof information to send the notification (e.g., the notification and aphone number to send the notification to). In this manner, the identityof the patient and the user may be protected from inadvertent disclosureby the message vendor 1016. In some examples, the message vendor 1016 isincluded as part of the notification service 1002. In this example, thenotification service 1002 may generate and send the message to the userdevice 1012. At 1126, the process 1100 provides the notification. Insome examples, the message vendor 1016 provides the notification. Insome examples, providing the notification may include adjusting thenotification to comply with a messaging standard and sending thenotification to the user device 1012. In some examples, the messagevendor 1016 performs on or more encryption techniques on thenotification prior to sending the notification to the user device at1128.

At 1128, the process 1100 receives the notification. In some examples,the user device 1012 receives the notification. Receiving thenotification may include receiving the notification in the form of anSMS, MMS, email, or other electronic messaging service. In someexamples, receiving the notification includes performing one or moredecryption techniques on the notification. In some examples, whensuitable encryption and decryption techniques are used, personal healthinformation may be shared in notifications.

Turning next to example acts and/or procedures that may be performedusing techniques described herein, in accordance with at least oneexample. FIG. 12 depicts process 1200 including example acts fortechniques relating to providing notifications to user devices inaccordance with at least one example. Some or all of the process 1200(or any other processes described herein, or variations and/orcombinations thereof) may be performed under the control of one or morecomputer systems configured with executable instructions and may beimplemented as code (e.g., executable instructions, one or more computerprograms or one or more applications) executing collectively on one ormore processors, by hardware or combinations thereof. The code may bestored on a computer-readable storage medium, for example, in the formof a computer program comprising a plurality of instructions executableby one or more processors. The computer-readable storage medium may benon-transitory. The notification module 1022 (FIG. 10 ) of thenotification service 1002 (FIG. 10 ) may perform the process 1200 ofFIG. 12 . The process 1200 begins at 1202 by receiving a notificationrequest. In some examples, receiving the notification request isperformed by the initiation engine 1044 (FIG. 10 ). The notificationrequest may be provided by a first user device of a first user. Thefirst user may be a patient of a medical care provider. The notificationrequest may indicate that one or more second user devices be providedwith notifications specifying one or more decisions made or actionsperformed in relation to responding to current conditions pertaining tothe first user. In some examples, the notification request does notidentify particular user devices, but instead identifies particularusers which may receive notifications. In some examples, thenotification request simply requests that notifications be provided toall authorized users.

At 1204, the process 1200 receives an authorization request. In someexamples, receiving the authorization request is performed by theauthentication engine 1046 (FIG. 10 ). The authorization request may bereceived from a second user device of the one or more second userdevices identified by the notification request. A second user of thesecond user device may be a relative or friend of the first user (e.g.,the patient), or may otherwise be associated with the first user. Insome examples, the second user is a medical professional treating thefirst user.

At 1206, the process 1200 determines whether the second user isauthorized. In some examples, determining whether the second user isauthorized is performed by the authentication engine 1046. In someexamples, the authorization request includes identifying informationcapable of identifying the first user. In some examples, the first userprovides the second user with the identifying information prior to thesecond user sending the authorization request. At least a portion of theidentifying information may be used to determine that the second userdevice (and second user) is authorized to receive the notifications. Forexample, when the identifying information provided by the second usermatches corresponding information in a record of the user, the seconduser may be authorized. In some examples, determining whether the seconduser is authorized may include comparing a unique device identifier witha list of device identifiers of authorized devices. In some examples,the authorization request includes a unique authorization code (e.g., arandomly-generated alphanumeric code). A corresponding code may havebeen previously generated when the first user provided the notificationrequest. Using the unique code, the authorization code may be comparedto the earlier-generated code to determine whether the codes match.

If the answer at 1206 is NO, the process 1200 continues to 1208 wherethe process 1200 performs an interactive authorization technique. Insome examples, performing the interactive authorization technique may beperformed by the authentication engine 1046. In some examples, this mayinclude transmitting a communication to the second user device thatrequests a response. For example, the authentication engine 1046 mayinteract with the second user device in manner to ensure that the seconduser device (and second user) are authorized. For example, theauthentication engine 1046 may pose one or more questions, which thesecond user of the second user device must answer correctly prior tobeing authorized.

Like at 1206, at 1210, the process 1200 determines whether authorizationof the second user has been successful. If NO, the process 1200continues to 1212 where the process ends. If YES, the process 1200continues to 1214 where records of the first user are monitored.Similarly, if the user is authorized at 1206, the process 1200 continuesto 1214 where records of the first user are monitored. In some examples,monitoring records of the first user may be performed by the listeningengine 1038 (FIG. 10 ). This may include, for example, initiating one ormore listeners to monitor messages flowing over a messaging bus toidentify those messages which identify the first user or the first userdevice. In some examples, the message may not identify the first user,but may otherwise be relevant to the treatment of the first user. Forexample, the messages may be generic for all user (e.g., emergencymessages, generic advertisements, and the like).

At 1216, the process 1200 identifies a message. In some examples,identifying a message may be performed by the listening engine 1038. Insome examples, identifying a message may include identifying a change ina record of the first user. For example, identifying the record changemay include recognizing a difference in medical record information. Forexample, if at T-1 the first user's (e.g., the patient) blood pressurewas 120/80, but at a later time, T-2, the same user's blood pressure is139/89. The record change may be identified by comparing the twoentries. In some examples, identifying a message may include identifyingany change or entry to the first user's record. In some examples,identifying the message includes determining whether a change in thefirst user's record is the type of change that should be reported out tothe user. For example, in the blood pressure example, the increase from120/80 to 139/89 is within prehypertension range. However, depending onsets of notification rules (descried herein), the system can beconfigured to notify users on blood pressure changes when the changedrecord is above stage 1 hypertension (e.g., >140/90).

In some examples, identifying the message may include comparing anamount of change of a medical record associated with the messagecompared to a predetermined value. In some examples, the change is anamount of words added or subtracted from the medical record. In otherwords, in some examples, it is inefficient to determine the substance ofthe change. Rather, it is more efficient to determine the amount ofchange based on some objective factor (e.g., increase or decrease innumber of words, letters, or numbers, changes to numbers, addition ordeletion of records, changes in events representable in binary format(e.g., admitted/discharged, in surgery/out of surgery), etc.). In thismanner, the service efficiently notifies users.

At 1218, the process 1200 determines whether to notify the second user.In some examples, determining whether to notify the second user may beperformed by the routing engine 1042. Determining whether to notify thesecond user may include accessing one or more notification rules todetermining if the identified message, which may include a change to thefirst user's record, should be reported out to the second user. In someexamples, the notification rules are specific to the first user. Somerules may be generally applicable to all users. Such rules may indicate,under what circumstances, if any, identifying information may beincluded in notification. In some examples, higher and lower levels ofdetails may be provided to different users. For example, a family membermay want a different level of detail than a medical care professional.In some examples, even minute details may be relevant to the medicalprofessional, while the family member may only want to receivenotifications that indicate bigger items.

If the answer at 1218 is NO, the process 1200 returns to 1214 to monitormessages of the first user. If the answer at 1218 is YES, the process1200 proceeds to 1220 to initialize a send procedure. Initializing thesend procedure may be performed by the routing engine 1042. Thediscussion of possible send procedures continues with reference to FIG.13 .

FIG. 13 depicts process 1300 including example acts for techniquesrelating to providing notifications to user devices in accordance withat least one example. The notification module 1022 (FIG. 10 ) of thenotification service 1002 (FIG. 10 ) may perform the process 1300 ofFIG. 13 . The process 1300 begins at 1302 by initializing a sendprocedure. As described with reference to FIG. 12 , at 1302, the seconduser may already have been authorized. In some examples, initializingthe send procedure may be performed by the routing engine 1042 (FIG. 10).

At 1304, the process 1300 receives instructions to notify one or moreusers of changes to medical record information. In some examples,receiving instructions may be performed by the routing engine 1042. Insome examples, the instructions were previously received and stored inassociation with the first user (e.g., the patient).

At 1306, the process 1300 determines whether a notification (to be sentto users) include some form of personal health information (PHI). If thenotification does contain PHI, the process 1300 continues to 1308 wherethe process determines whether to encrypt the notification. In someexamples, determining whether to encrypt the notification may beperformed by the modification engine 1040 (FIG. 10 ). If the answer at1306 is NO, the process 1300 continues to 1310 where the process endsthe send procedure. If the answer at 1308 is YES, the process 1300continues to 1312, where the notification is encrypted using one or moreencryption techniques described herein. In some examples, encrypting maybe performed by the modification engine 1040.

The process 1300 then continues to 1314 where the process 1300 sends thenotification to the second user. In some examples, send the notificationmay be performed by the routing engine 1042. In some examples, sendingthe notification to the second user may include sending the message viaone or more vendors (e.g., the message vendor 1016). In other examples,sending the notification to the second user may include sending thenotification directly via text message, via email, via an applicationrunning on a user device, or the like.

At 1316, the process 1300 determines whether a response to thenotification is expected. In some examples, determining whether theresponse to the notification is expected is performed by theauthentication engine 1046 (FIG. 10 ). A response may be expected if thenotification included a question. For example, a notification mayindicate that the first user has finished a procedure and is ready to bepicked up and may request that the second user indicate whether thesecond user can pick up the first user within a certain time period. Ifa response is not expected, the process 1300 continues to 1310 where theprocedure ends. If, on the other hand, a response is expected, theprocess 1300 continues to 1318 where a response is received. In someexamples, receiving the response may be performed by the routing engine1042. Receiving the response may include receiving a response from thesecond user via SMS, via email, via an application running on the mobiledevice, or the like.

At 1320, the process 1300 determines the response. In some examples,determining the response may be performed by the authentication engine1046. Determining the response may include determining whether theresponse received at 1318 was responsive to the notification sent at1314. In some examples, the response is determined to be non-responsivewhen the received response does not answer the questions posed in thenotification, is received after a predetermined time, or the like.

At 1322, the process 1300 determines whether additional responses areexpected. In some examples, determining whether additional response areexpected may be performed by the authentication engine 1046. If NO, theprocess 1300 ends at 1310. If YES, the process 1300 feeds back into theflow between 1304 and 1306. In this manner, the process 1300 continuesto communicate back and forth with the user.

Specific details are given in the above description to provide athorough understanding of the embodiments. However, it is understoodthat the embodiments may be practiced without these specific details.For example, circuits may be shown in block diagrams in order not toobscure the embodiments in unnecessary detail. In other instances,well-known circuits, processes, algorithms, structures, and techniquesmay be shown without unnecessary detail in order to avoid obscuring theembodiments.

Implementation of the techniques, blocks, steps and means describedabove may be done in various ways. For example, these techniques,blocks, steps and means may be implemented in hardware, software, or acombination thereof. For a hardware implementation, the processing unitsmay be implemented within one or more application specific integratedcircuits (ASICs), digital signal processors (DSPs), digital signalprocessing devices (DSPDs), programmable logic devices (PLDs), fieldprogrammable gate arrays (FPGAs), processors, controllers,micro-controllers, microprocessors, other electronic units designed toperform the functions described above, and/or a combination thereof.

Also, it is noted that the embodiments may be described as a processwhich is depicted as a flowchart, a flow diagram, a swim diagram, a dataflow diagram, a structure diagram, or a block diagram. Although adepiction may describe the operations as a sequential process, many ofthe operations can be performed in parallel or concurrently. Inaddition, the order of the operations may be re-arranged. A process isterminated when its operations are completed, but could have additionalsteps not included in the figure. A process may correspond to a method,a function, a procedure, a subroutine, a subprogram, etc. When a processcorresponds to a function, its termination corresponds to a return ofthe function to the calling function or the main function.

Furthermore, embodiments may be implemented by hardware, software,scripting languages, firmware, middleware, microcode, hardwaredescription languages, and/or any combination thereof. When implementedin software, firmware, middleware, scripting language, and/or microcode,the program code or code segments to perform the necessary tasks may bestored in a machine readable medium such as a storage medium. A codesegment or machine-executable instruction may represent a procedure, afunction, a subprogram, a program, a routine, a subroutine, a module, asoftware package, a script, a class, or any combination of instructions,data structures, and/or program statements. A code segment may becoupled to another code segment or a hardware circuit by passing and/orreceiving information, data, arguments, parameters, and/or memorycontents. Information, arguments, parameters, data, etc. may be passed,forwarded, or transmitted via any suitable means including memorysharing, message passing, token passing, network transmission, etc.

For a firmware and/or software implementation, the methodologies may beimplemented with modules (e.g., procedures, functions, and so on) thatperform the functions described herein. Any machine-readable mediumtangibly embodying instructions may be used in implementing themethodologies described herein. For example, software codes may bestored in a memory. Memory may be implemented within the processor orexternal to the processor. As used herein the term “memory” refers toany type of long term, short term, volatile, nonvolatile, or otherstorage medium and is not to be limited to any particular type of memoryor number of memories, or type of media upon which memory is stored.

Moreover, as disclosed herein, the term “storage medium” may representone or more memories for storing data, including read only memory (ROM),random access memory (RAM), magnetic RAM, core memory, magnetic diskstorage mediums, optical storage mediums, flash memory devices and/orother machine readable mediums for storing information. The term“machine-readable medium” includes, but is not limited to portable orfixed storage devices, optical storage devices, and/or various otherstorage mediums capable of storing that contain or carry instruction(s)and/or data.

While the principles of the disclosure have been described above inconnection with specific apparatuses and methods, it is to be clearlyunderstood that this description is made only by way of example and notas limitation on the scope of the disclosure.

What is claimed:
 1. A system to route medical message content from aplurality of different sources for access by a plurality of differentendpoint devices, the system comprising: one or more network interfaces;memory configured to store computer-executable instructions; and one ormore servers comprising one or more processors in communication with thememory and configured to execute the computer-executable instructions toperform actions comprising: monitoring for medical messages transmittedfrom the plurality of different sources corresponding to electronicdevices communicably couplable via a network comprising a messaging bus;processing a first message from a first electronic device of theelectronic devices; identifying a first identifier corresponding to afirst recipient for the first message, the first recipient correspondingto a first endpoint of a plurality of different endpoints; identifying afirst notification method selected from a plurality of notificationmethods provided at least in part by a notification service fortransmission of a first notification based at least in part on a firstset of rules comprising notification rules that are machine-learned andspecific to the first recipient; when a communication channelcorresponding to the first notification method is unsecured: modifyingthe first message with a first set of modification operations, themodifying comprising processing the first message to comply withregulations limiting health information exchanged using unsecuredcommunication channels; generating the first notification in accordancewith the first notification method selected from the plurality ofnotification methods; and causing transmission of the first notificationcomprising a portion of the first message in accordance with the firstnotification method; processing a second message from the firstelectronic device or a second electronic device of the electronicdevices; identifying a second identifier corresponding to a secondrecipient for the second message, the second recipient corresponding toa second endpoint of the plurality of different endpoints; authorizingthe second recipient by the notification service using authorizedidentification information associated with the second recipient that waspreviously received by the notification service from the secondrecipient; identifying a second notification method selected from theplurality of notification methods for transmission of a secondnotification based at least in part on a second set of rules comprisingnotification rules that are machine-learned and specific to the secondrecipient; when a communication channel corresponding to the secondnotification method is secured: modifying the second message with asecond set of modification operations, the modifying comprisingprocessing the second message to determine at least a portion of thesecond message to pull for inclusion in the second notification, wherethe second set of modification operations differs from the first set ofmodification operations at least in that protected health information isnot removed from the portion of the second message; generating thesecond notification in accordance with the second notification methodselected from the plurality of notification methods; and causingtransmission of the second notification comprising the portion of thesecond message in accordance with the second notification method.
 2. Thesystem to route message content from a plurality of different sourcesfor access by a plurality of different endpoint devices as recited inclaim 1, where the generating the first notification comprises includingthe portion of the first message in the first notification but notanother portion of the first message.
 3. The system to route messagecontent from a plurality of different sources for access by a pluralityof different endpoint devices as recited in claim 2, where thegenerating the first notification comprises performing languagetranslation of at least part of the first message from a first languageto a second language, and the generating the second notificationcomprises performing language translation of at least part of the secondmessage to a third language.
 4. The system to route message content froma plurality of different sources for access by a plurality of differentendpoint devices as recited in claim 3, where: the causing transmissionof the first notification comprises providing the first notification anda first destination indicator corresponding to the first recipient to asecond system, and instructing the second system to transmit the firstnotification using the first notification method; and the causingtransmission of the second notification comprises providing the secondnotification and a second destination indicator corresponding to thesecond recipient to the second system or a third system, and instructingthe second system or the third system to transmit the secondnotification using the second notification method.
 5. The system toroute message content from a plurality of different sources for accessby a plurality of different endpoint devices as recited in claim 4,where the second system is a messaging service, and the third system isa different messaging service.
 6. A method for routing medical messagecontent from a plurality of different sources for access by a pluralityof different endpoint devices, the method comprising: monitoring formedical messages transmitted from the plurality of different sourcescorresponding to electronic devices communicably couplable via a networkcomprising a messaging bus; processing a first message from a firstelectronic device of the electronic devices; identifying a firstidentifier corresponding to a first recipient for the first message, thefirst recipient corresponding to a first endpoint of a plurality ofdifferent endpoints; identifying a first notification method selectedfrom a plurality of notification methods provided at least in part by anotification service for transmission of a first notification based atleast in part on a first set of rules comprising notification rules thatare machine-learned and specific to the first recipient; when acommunication channel corresponding to the first notification method isunsecured: modifying the first message with a first set of modificationoperations, the modifying comprising processing the first message tocomply with regulations limiting health information exchanged usingunsecured communication channels; generating the first notification inaccordance with the first notification method selected from theplurality of notification methods; and causing transmission of the firstnotification comprising a portion of the first message in accordancewith the first notification method; processing a second message from thefirst electronic device or a second electronic device of the electronicdevices; identifying a second identifier corresponding to a secondrecipient for the second message, the second recipient corresponding toa second endpoint of the plurality of different endpoints; authorizingthe second recipient by the notification service using authorizedidentification information associated with the second recipient that waspreviously received by the notification service from the secondrecipient; identifying a second notification method selected from theplurality of notification methods for transmission of a secondnotification based at least in part on a second set of rules comprisingnotification rules that are machine-learned and specific to the secondrecipient; when a communication channel corresponding to the secondnotification method is secured: modifying the second message with asecond set of modification operations, the modifying comprisingprocessing the second message to determine at least a portion of thesecond message to pull for inclusion in the second notification, wherethe second set of modification operations differs from the first set ofmodification operations at least in that protected health information isnot removed from the portion of the second message; generating thesecond notification in accordance with the second notification methodselected from the plurality of notification methods; and causingtransmission of the second notification comprising the portion of thesecond message in accordance with the second notification method.
 7. Themethod for routing message content from a plurality of different sourcesfor access by a plurality of different endpoint devices as recited inclaim 6, where the generating the first notification comprises includingthe portion of the first message in the first notification but notanother portion of the first message.
 8. The method for routing messagecontent from a plurality of different sources for access by a pluralityof different endpoint devices as recited in claim 7, where thegenerating the first notification comprises performing languagetranslation of at least part of the first message from a first languageto a second language, and the generating the second notificationcomprises performing language translation of at least part of the secondmessage to a third language.
 9. The method for routing message contentfrom a plurality of different sources for access by a plurality ofdifferent endpoint devices as recited in claim 8, where: the causingtransmission of the first notification comprises providing the firstnotification and a first destination indicator corresponding to thefirst recipient to a second system, and instructing the second system totransmit the first notification using the first notification method; andthe causing transmission of the second notification comprises providingthe second notification and a second destination indicator correspondingto the second recipient to the second system or a third system, andinstructing the second system or the third system to transmit the secondnotification using the second notification method.
 10. The method forrouting message content from a plurality of different sources for accessby a plurality of different endpoint devices as recited in claim 9,where the second system is a messaging service, and the third system isa different messaging service.
 11. One or more computer-readable storagedevices for storing computer-executable instructions that, when executedby one or more computer systems, configure the one or more computersystems to perform operations for routing medical message content from aplurality of different sources for access by a plurality of differentendpoint devices, the operations comprising: monitoring for medicalmessages transmitted from the plurality of different sourcescorresponding to electronic devices communicably couplable via a networkcomprising a messaging bus; processing a first message from a firstelectronic device of the electronic devices; identifying a firstidentifier corresponding to a first recipient for the first message, thefirst recipient corresponding to a first endpoint of a plurality ofdifferent endpoints; identifying a first notification method selectedfrom a plurality of notification methods provided at least in part by anotification service for transmission of a first notification based atleast in part on a first set of rules comprising notification rules thatare machine-learned and specific to the first recipient; when acommunication channel corresponding to the first notification method isunsecured: modifying the first message with a first set of modificationoperations, the modifying comprising processing the first message tocomply with regulations limiting health information exchanged usingunsecured communication channels; generating the first notification inaccordance with the first notification method selected from theplurality of notification methods; and causing transmission of the firstnotification comprising a portion of the first message in accordancewith the first notification method; processing a second message from thefirst electronic device or a second electronic device of the electronicdevices; identifying a second identifier corresponding to a secondrecipient for the second message, the second recipient corresponding toa second endpoint of the plurality of different endpoints; authorizingthe second recipient by the notification service using authorizedidentification information associated with the second recipient that waspreviously received by the notification service from the secondrecipient; identifying a second notification method selected from theplurality of notification methods for transmission of the secondnotification based at least in part on a second set of rules comprisingnotification rules that are machine-learned and specific to the secondrecipient; when a communication channel corresponding to the secondnotification method is secured: modifying the second message with asecond set of modification operations, the modifying comprisingprocessing the second message to determine at least a portion of thesecond message to pull for inclusion in a second notification, where thesecond set of modification operations differs from the first set ofmodification operations at least in that protected health information isnot removed from the portion of the second message; generating thesecond notification in accordance with the second notification methodselected from the plurality of notification methods; and causingtransmission of the second notification comprising the portion of thesecond message in accordance with the second notification method. 12.The one or more computer-readable storage devices as recited in claim11, where the generating the first notification comprises including theportion of the first message in the first notification but not anotherportion of the first message.
 13. The one or more computer-readablestorage devices as recited in claim 12, where the generating the firstnotification comprises performing language translation of at least partof the first message from a first language to a second language, and thegenerating the second notification comprises performing languagetranslation of at least part of the second message to a third language.14. The one or more computer-readable storage devices as recited inclaim 13, where: the causing transmission of the first notificationcomprises providing the first notification and a first destinationindicator corresponding to the first recipient to a second system, andinstructing the second system to transmit the first notification usingthe first notification method; and the causing transmission of thesecond notification comprises providing the second notification and asecond destination indicator corresponding to the second recipient tothe second system or a third system, and instructing the second systemor the third system to transmit the second notification using the secondnotification method.